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Sample records for previous lumbar spinal

  1. Lumbar Spinal Canal Stenosis

    MedlinePlus

    ... time. This narrowing is called “stenosis.” As the lumbar spinal canal narrows, the nerves that go through it are squeezed. This squeezing ... chest). It’s thought that these positions “open” the lumbar canal and take the pressure off the nerves that go to the legs. In severe cases, ...

  2. Biomechanical implications of lumbar spinal ligament transection.

    PubMed

    Von Forell, Gregory A; Bowden, Anton E

    2014-11-01

    Many lumbar spine surgeries either intentionally or inadvertently damage or transect spinal ligaments. The purpose of this work was to quantify the previously unknown biomechanical consequences of isolated spinal ligament transection on the remaining spinal ligaments (stress transfer), vertebrae (bone remodelling stimulus) and intervertebral discs (disc pressure) of the lumbar spine. A finite element model of the full lumbar spine was developed and validated against experimental data and tested in the primary modes of spinal motion in the intact condition. Once a ligament was removed, stress increased in the remaining spinal ligaments and changes occurred in vertebral strain energy, but disc pressure remained similar. All major biomechanical changes occurred at the same spinal level as the transected ligament, with minor changes at adjacent levels. This work demonstrates that iatrogenic damage to spinal ligaments disturbs the load sharing within the spinal ligament network and may induce significant clinically relevant changes in the spinal motion segment.

  3. 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

  4. Lumbar Spinal Stenosis

    PubMed Central

    Genevay, Stephane

    2009-01-01

    Lumbar spinal stenosis (LSS) is most commonly due to degenerative changes in older individuals. LSS is being more commonly diagnosed and may relate to better access to advanced imaging and to an aging population. This review focuses on radicular symptoms related to degenerative central and lateral stenosis and updates knowledge of LSS pathophysiology, diagnosis and management. Since patients with anatomic LSS can range from asymptomatic to severely disabled, the clinical diagnosis focuses on symptoms and examination findings associated with LSS. Imaging findings are helpful for patients with persistent, bothersome symptoms in whom invasive treatments are being considered. There is limited information from high quality studies about the relative benefits and harms of commonly used treatments. Interpreting and comparing results of available research is limited by a lack of consensus about the definition of LSS. Nevertheless, evidence supports decompressive laminectomy for patients with persistent and bothersome symptoms. Recommendations favor a shared decision making approach due to important trade-offs between alternative therapies and differences among patients in their preferences and values. PMID:20227646

  5. Management of lumbar spinal stenosis.

    PubMed

    Lurie, Jon; Tomkins-Lane, Christy

    2016-01-04

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

  6. Occult lumbar spinal stenosis.

    PubMed Central

    Choudhury, A R; Taylor, J C

    1977-01-01

    Twenty-eight patients presenting with low back pain, associated with sciatic or femoral neuropathy, were found to have lateral recess stenosis occurring as a result of hypertrophy of the facet joints, with preservation within normal limits of the sagittal AP diameter of the lumbar canal. Pathology was believed to be traumatic in origin, and the variable nature of the adhesions suggested recurrent inflammation; the hypertrophy of the facet joints may have been the result of traumatic inflammatory hyperaemia. Radiological investigations were unhelpful. The diagnosis of the condition was made at the time of surgical exploration by the findings of alteration of the facet joints, adhesions and fixity of the nerve roots, normal sagittal AP diameter of the canal, and absence of other significant lesions. Gratifying results were obtained with decompression by wide laminectomy with excision of overhanging facet joints and release of adhesions. PMID:894321

  7. Impaired lumbar movement perception in association with postural stability and motor- and somatosensory-evoked potentials in lumbar spinal stenosis.

    PubMed

    Leinonen, Ville; Määttä, Sara; Taimela, Simo; Herno, Arto; Kankaanpää, Markku; Partanen, Juhani; Kansanen, Martti; Hänninen, Osmo; Airaksinen, Olavi

    2002-05-01

    A descriptive study of the associations between different neurophysiologic findings in patients with lumbar spinal stenosis. To evaluate the ability to sense a change in lumbar position and the associations between lumbar movement perception, postural stability, and motor-evoked potentials and somatosensory-evoked potentials. Patients with low back pain have impaired postural control and impaired lumbar proprioception. Altered motor-evoked potentials and somatosensory-evoked potentials have been often observed in lumbar spinal stenosis. The study included 26 patients with clinically and radiologically diagnosed lumbar spinal stenosis. Their ability to sense lumbar rotation was assessed in a previously validated motorized trunk rotation unit in the seated position. The abilities to indicate the movement direction and the movement magnitude were used as indexes of the ability to sense the lumbar rotatory movement. The postural stability was measured with a vertical force platform. The motor-evoked potentials were elicited by transcranial and lumbar stimulation and recorded from anterior tibialis muscles. The somatosensory-evoked potentials were elicited by transcutaneous electrical stimulation of the tibial nerve at the ankle. Twenty patients (76.9%; P = 0.006) reported the wrong movement direction. Furthermore, the patients consistently localized the movement sensation in their shoulders instead of the lumbar region. The altered motor-evoked potentials and somatosensory-evoked potentials were observed in 11 and 16 patients, respectively. Abnormal motor-evoked potentials had inconsistent associations with impaired movement perception and postural stability and abnormal somatosensory-evoked potentials had no associations with other findings. Many patients with lumbar spinal stenosis have difficulties in sensing the lumbar rotational movement, which may indicate impaired proprioceptive abilities. Abnormal motor-evoked potentials and somatosensory-evoked potentials are

  8. Imaging of current spinal hardware: lumbar spine.

    PubMed

    Ha, Alice S; Petscavage-Thomas, Jonelle M

    2014-09-01

    The purposes of this article are to review the indications for and the materials and designs of hardware more commonly used in the lumbar spine; to discuss alternatives for each of the types of hardware; to review normal postoperative imaging findings; to describe the appropriateness of different imaging modalities for postoperative evaluation; and to show examples of hardware complications. Stabilization and fusion of the lumbar spine with intervertebral disk replacement, artificial ligaments, spinous process distraction devices, plate-and-rod systems, dynamic posterior fusion devices, and newer types of material incorporation are increasingly more common in contemporary surgical practice. These spinal hardware devices will be seen more often in radiology practice. Successful postoperative radiologic evaluation of this spinal hardware necessitates an understanding of fundamental hardware design, physiologic objectives, normal postoperative imaging appearances, and unique complications. Radiologists may have little training and experience with the new and modified types of hardware used in the lumbar spine.

  9. Degenerative lumbar spinal stenosis and lumbar spine configuration

    PubMed Central

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

    2010-01-01

    As life expectancy increases, degenerative lumbar spinal stenosis (DLSS) becomes a common health problem among the elderly. DLSS is usually caused by degenerative changes in bony and/or soft tissue elements. The poor correlation between radiological manifestations and the clinical picture emphasizes the fact that more studies are required to determine the natural course of this syndrome. Our aim was to reveal the association between lower lumbar spine configuration and DLSS. Two groups were studied: the first included 67 individuals with DLSS (mean age 66 ± 10) and the second 100 individuals (mean age 63.4 ± 13) without DLSS-related symptoms. Both groups underwent CT images (Philips Brilliance 64) and the following measurements were performed: a cross-section area of the dural sac, vertebral body dimensions (height, length and width), AP diameter of the bony spinal canal, lumbar lordosis and sacral slope angles. All measurements were taken at L3 to S1. Vertebral body lengths were significantly greater in the DLSS group at all levels compared to the control, whereas anterior vertebral body heights (L3, L4, L5) and middle vertebral heights (L3, L5) were significantly smaller in the LSS group. Lumbar lordosis, sacral slope and bony spinal canal were significantly smaller in the DLSS compared to the control. We conclude that the size and shape of vertebral bodies and canals significantly differed between the study groups. A tentative model is suggested to explain the association between these characteristics and the development of degenerative spinal stenosis. PMID:20652366

  10. Characteristics of thoracic and lumbar movements during gait in lumbar spinal stenosis patients before and after decompression surgery.

    PubMed

    Kuwahara, Wataru; Deie, Masataka; Fujita, Naoto; Tanaka, Nobuhiro; Nakanishi, Kazuyoshi; Sunagawa, Toru; Asaeda, Makoto; Nakamura, Haruka; Kono, Yoshifumi; Ochi, Mitsuo

    2016-12-01

    Although gait analysis has been previously conducted for lumbar spinal stenosis patients, the vertebral segmental movements, such as of the thoracic and lumbar regions, and whether the spinal movement during gait changes after decompression surgery remain unclear. Ten patients with lumbar spinal stenosis and 10 healthy controls participated. Clinical outcomes were assessed using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire and Visual Analogue Scale. Spinal kinematic data of the participants during gait were acquired using a three-dimensional motion analysis system. The trunk (whole spine), thoracic, and lumbar flexion and pelvic tilting values were calculated. Spinal kinematic data and clinical outcomes were collected preoperatively and 1month postoperatively for the patients. Compared to that observed preoperatively, the clinical outcomes significantly improved at 1month postoperatively. In the standing position, the preoperative lumbar extension of the patients was significantly smaller than that of the controls. Moreover, during gait, the lumbar flexion relative to the standing position of the patients was smaller than that of the controls preoperatively, and increased at 1month postoperatively. The sum of the thoracic and lumbar flexion values during gait negatively correlated with the score for leg pain. The epidural pressure of lumbar spinal stenosis patients is known to be higher than that of normal subjects during gait, and to decrease during walking with lumbar flexion. Preoperatively, smaller thoracic and lumbar flexion movements during gait relative to the standing position cannot decrease epidural pressure; as a result, severe leg pain might be induced. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Percutaneous endoscopic transforaminal lumbar spinal canal decompression for lumbar spinal stenosis

    PubMed Central

    Wen, Bingtao; Zhang, Xifeng; Zhang, Lin; Huang, Peng; Zheng, Guoquan

    2016-01-01

    Abstract This study aimed to evaluate the safety and curative effect of percutaneous endoscopic transforaminal lumbar spinal canal decompression in the treatment of lumbar spinal stenosis. This retrospective study recruited 64 patients with lumbar spinal stenosis who underwent percutaneous endoscopic lumbar spinal canal decompression via surgical approach of posterolateral intervertebral foramen. The postoperation neurological function and pain status were evaluated by the visual analog scale (VAS) score of pain and the Oswestry disability index (ODI), and the patient satisfaction was evaluated according to the MacNab outcome criteria. The data, including preoperative comorbidities, operation time, the quantity of bleeding, bed rest time, and intraoperative and postoperative complications, were recorded. The mean operation time was 78 min, the mean quantity of bleeding was 20 mL and bed rest time was 6 h to 3 days. All patients were followed-up for 4 months to 5 years. The mean preoperative VAS score was 7.7 ± 1.2, while postoperative 3 months, 6 months, and final follow-up VAS scores were 2.8 ± 0.7, 2.1 ± 0.6, and 0.8 ± 0.6, respectively (P < 0.001). The mean preoperative ODI score was 72.4 ± 1.2, while postoperative 3 months, 6 months, and final follow-up ODI scores were 29.7 ± 4.9, 23.9 ± 4.0, and 12.5 ± 3.9, respectively (P < 0.001). The excellent and good rate reached 73.4% at the final follow-up. The percutaneous endoscopic transforaminal lumbar spinal canal decompression is an easy, safe, and effective minimally invasive surgery for patients with lumbar spinal stenosis. PMID:27977571

  12. Tophaceous gout of the lumbar spine mimicking a spinal meningioma.

    PubMed

    Ribeiro da Cunha, Pedro; Peliz, António Judice; Barbosa, Marcos

    2016-11-05

    Although gout is a common metabolic disorder, it usually affects distal joints of the appendicular skeleton. Axial spine involvement is rare, with only 131 cases reported in the literature. The authors report a rare case of lumbar spinal gout mimicking a spinal meningioma. A 77-year-old man with a history of gout presented with chronic low back pain and progressive paraparesis. Imaging revealed a lumbar spine compressive mass lesion with a dural tail signal. The differential diagnosis was thought to be straightforward favoring a spinal meningioma. Tophaceous gout was never considered. The presence of a dural tail associated with the lesion is an interesting detail of this case, that strongly misguided it and to the best of our knowledge it is the first one reported in the literature. The patient underwent surgery and intra-operative findings were surprisingly different from those expected, revealing a chalky white mass lesion firmly adherent and compressing the dural sac. It was completely excised, leaving the dura intact. Histopathology confirmed the diagnosis of tophaceous gout. The patient was sent to physical therapy and had a complete remission of pain and neurological deficit, regaining his walking capacity. Although spinal gout is rare, it should be considered in the differential diagnosis for patients presenting with symptoms of spinal stenosis, a suspicion of neoplastic lesion of the spine, and a previous history of gout. Early diagnosis can ensure proper and timely medical management, perhaps avoiding neurological compromise and the need for surgery.

  13. Lumbar spinal muscles and spinal canal study by MRI three-dimensional reconstruction in adult lumbar spinal stenosis.

    PubMed

    Boissière, L; Moal, B; Gille, O; De-Roquefeuil, E; Durieux, M; Obeid, I; Dousset, V; Vital, J-M; Skalli, W

    2017-04-01

    Lumbar spinal stenosis is degenerative disc disease most common manifestation. If stenosis degree seems poorly related to symptom severity, lumbar muscles role is recognized. Many studies report imaging methods, to analyze muscle volumes and fat infiltration (FI), but remain limited due to the difficulty to represent entire muscle volume variability. Recently a 3D muscle reconstruction protocol (using the deformation of a parametric specific object method (DPSO) and three-point Dixon images) was reported. It offers the ability to evaluate, muscles volumes and muscle FI. To describe, in a lumbar spinal stenosis population, muscle volumes, muscle FI and lumbar spinal canal volume with 3D MRI images reconstructions. Ten adults presenting L4-L5 lumbar stenosis, were included. After specific MRI protocol, three-dimensional, muscle and spinal canal, reconstructions were performed. Muscle (psoas and paraspinal muscles) volumes and fat infiltration (FI), the spinal canal volume, age, and height were correlated one to each other with Spearman correlation factor. An ANOVA was performed to evaluate the intervertebral level influence (P≤0.05). Muscle volumes correlated with height (r=0.68 for psoas). Muscles FI correlated with age (r=0.66 for psoas) and lumbar spinal canal volume (r=0.91). Psoas and paraspinal volumes were maximum at L3-L4 level whereas FI increased from L1-L2 to L5-S1 level. These first results illustrate the importance to consider muscles entirely and report correlations between muscles FI, lumbar spinal canal volume and age; and between muscle volumes and patients height. Muscle degeneration seems more related to muscle FI than muscle volume. 3. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

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

    PubMed

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

    2016-01-01

    Although there are currently less invasive techniques available for the treatment of spinal injuries, open surgery is still required in many cases. Vascular injuries occurring during lumbar spine surgery, although uncommon, are of great importance due to their potential gravity. Clinical manifestations vary from an acute hemorrhagic shock that needs urgent treatment to save the patient's life, to insidious injuries or an asymptomatic evolution, and should be studied to choose the best therapeutic alternative. Four cases are reported that represent this range of possibilities and emphasize the importance of a careful surgical technique during lumbar spine interventions, and the need for high clinical suspicion, essential for the early diagnosis of these vascular complications. The current therapeutic options are also discussed. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  15. Population reference range for developmental lumbar spinal canal size

    PubMed Central

    Huang, Junbin; Law, Sheung-Wai; Xiao, Fan; Leung, Jason Chi Shun; Wang, Defeng; Shi, Lin

    2016-01-01

    Background Considerable variability exists in normal developmental lumbar spinal canal size. This impacts the likelihood of neural compromise. Spinal canal development is complete by 17 years. As diseases incurred thereafter do not knowingly affect the developmental size of the spinal canal, it is reasonable to use a selected population undergoing abdominopelvic computed tomography (CT) examination to determine developmental lumbar spinal canal size. Methods Study approval was granted by the Clinical Research Ethics Committee. Between Feb 2014 and Jan 2015, mid-vertebral spinal canal cross-sectional area (CSA), depth, width, and vertebral body CSA at each level from L1–L5 was measured, using a semi-automated computerized method in 1,080 ambulatory patients (540 males, 540 females, mean age, 50.5±17 years). Patient height and weight was measured. Results A reference range for developmental lumbar spinal canal dimensions was developed at each lumbar level for each sex. There was a 34% variation in spinal canal CSA between smallest and largest quartiles. Developmental spinal canal CSA and depth were consistently smallest at L3, enlarging cranially and caudally. Taller people had slightly larger lumbar spinal canals (P<0.0001). Males had larger spinal canal CSAs than females though relative to vertebral body CSA, spinal canal CSA was larger in females. There was no change in spinal canal CSA with age, weight or BMI (P<0.05). Conclusions A population reference range for developmental lumbar spinal canal size was developed. This allows one to objectively determine the degree of developmental spinal canal stenosis present on an individual patient basis. PMID:28090445

  16. Surgical options for lumbar spinal stenosis.

    PubMed

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

    2016-11-01

    Hospital charges for lumbar spinal stenosis have increased significantly worldwide in recent times, with great variation in the costs and rates of different surgical procedures. There have also been significant increases in the rate of complex fusion and the use of spinal spacer implants compared to that of traditional decompression surgery, even though the former is known to incur costs up to three times higher. Moreover, the superiority of these new surgical procedures over traditional decompression surgery is still unclear. To determine the efficacy of surgery in the management of patients with symptomatic lumbar spinal stenosis and the comparative effectiveness between commonly performed surgical techniques to treat this condition on patient-related outcomes. We also aimed to investigate the safety of these surgical interventions by including perioperative surgical data and reoperation rates. Review authors performed electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, AMED, Web of Science, LILACS and three trials registries from their inception to 16 June 2016. Authors also conducted citation tracking on the reference lists of included trials and relevant systematic reviews. This review included only randomised controlled trials that investigated the efficacy and safety of surgery compared with no treatment, placebo or sham surgery, or with another surgical technique in patients with lumbar spinal stenosis. Two reviewers independently assessed the studies for inclusion and performed the 'Risk of bias' assessment, using the Cochrane Back and Neck Review Group criteria. Reviewers also extracted demographics, surgery details, and types of outcomes to describe the characteristics of included studies. Primary outcomes were pain intensity, physical function or disability status, quality of life, and recovery. The secondary outcomes included measurements related to surgery, such as perioperative blood loss

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

    PubMed

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

    2015-06-01

    The increase in the number of interventions for the management of chronic pain and associated escalation of healthcare costs has captured the attention of health policymakers, in no small part due to the lack of documentation of efficacy, cost-effectiveness, or cost utility analysis. A recent cost utility analysis of caudal epidural injections in managing chronic low back pain of various pathologies showed a high cost utility with improvement in quality of life years, competitive with various other modalities of treatments. However, there are no analyses derived from high-quality controlled studies related to the cost utility of percutaneous adhesiolysis in the treatment of post-lumbar surgery syndrome or lumbar central spinal stenosis. This analysis is based on 2 previously published controlled studies. To assess the cost utility of percutaneous adhesiolysis procedures in managing chronic low back and lower extremity pain secondary to post-lumbar surgery syndrome and lumbar central spinal stenosis. A private, specialty referral interventional pain management center in the United States. Two controlled studies were conducted assessing the clinical effectiveness of percutaneous adhesiolysis for post-lumbar surgery syndrome and lumbar central spinal stenosis in an interventional pain management setting utilizing contemporary interventional pain management practices. A cost utility analysis was performed with direct payment data for a total of 130 patients in treatment groups over a 2-year period. Various outcome measures were included with significant improvement, defined as at least 50% improvement with reduction in pain and disability status. The results of 2 controlled studies of low back pain with 60 and 70 patients and a 2-year follow-up with the actual reimbursement data showed cost utility for 1 year of quality-adjusted life year (QALY) of USD $2,652 for post-lumbar surgery syndrome and USD $2,649 for lumbar central spinal stenosis. The results of this

  18. Degenerative lumbar spinal stenosis and its imposters: three case studies

    PubMed Central

    Ammendolia, Carlo

    2014-01-01

    Degenerative lumbar spinal stenosis causing neurogenic claudicaton is a common condition impacting walking ability in older adults. There are other highly prevalent conditions in this patient population that have similar signs and symptoms and cause limited walking ability. The purpose of this study is to highlight the diagnostic challenges using three case studies of older adults who present with limited walking ability who have imaging evidence of degenerative lumbar spinal stenosis. PMID:25202160

  19. [Intermittent priapism as a clinical feature of lumbar spinal stenosis].

    PubMed

    Rojas, J I; Zurrú-Ganen, M C; Romano, M; Patrucco, L; Cristiano, E

    Lumbar spinal stenosis is defined as a narrowing of the neural canal and foramina that result in compression of the lumbosacral nerve roots or cauda equina. Patients with lumbar spinal stenosis may present a variety of signs and symptoms. One such syndrome is neurogenic intermittent claudication, characterized by radicular symptoms exacerbated by walking or standing and relieved by rest. Infrequently, lumbar spinal stenosis produces a cauda equina compression, characterized by intermittent urinary or fecal incontinence, impotence and in rare cases priapism. A 50 year-aged male, presented with spontaneous intermittent priapism and few months later weakness, numbness and pain of his legs provoked by bipedestation or physical exertion that completely disappeared by sitting or lying down. A computed tomographic scan showed a lumbar canal narrowing of L4 through L5. A diagnosis of neurogenic intermittent claudication with dysfunction of the cauda equina roots secondary to the presence of lumbar spinal stenosis was carried out. The symptoms completely resolved after descompressive lumbar laminectomy of L4 and L5. Causal interpretation of neurogenic intermittent claudication still remains obscure. An inadequate blood supply provoked by increased intra-raquid pressure among the roots may act as a dynamic factor. This mechanism could cause stagnant anoxia during the exercise resulting in clinical symptoms. Lumbar spinal stenosis should be kept in mind when autonomic features appear.

  20. [Enlargement in managment of lumbar spinal stenosis].

    PubMed

    Steib, J P; Averous, C; Brinckert, D; Lang, G

    1996-05-01

    Lumbar stenosis has been well discussed recently, especially at the 64th French Orthopaedic Society (SOFCOT: July 1989). The results of different surgical treatments were considered as good, but the indications for surgical treatment were not clear cut. Laminectomy is not the only treatment of spinal stenosis. Laminectomy is an approach with its own rate of complications (dural tear, fibrosis, instability... ).Eight years ago, J. Sénégas described what he called the "recalibrage" (enlargement). His feeling was that, in the spinal canal, we can find two different AP diameters. The first one is a fixed constitutional AP diameter (FCAPD) at the cephalic part of the lamina. The second one is a mobile constitutional AP diameter (MCAPD) marked by the disc and the ligamentum flavum. This diameter is maximal in flexion, minimal in extension. The nerve root proceeds through the lateral part of the canal: first above, between the disc and the superior articular process, then below, in the lateral recess bordered by the pedicle, the vertebral body and the posterior articulation. With the degenerative change the disc space becomes shorter, the superior articular process is worn out with osteophytes. These degenerative events are complicated by inter vertebral instability increasing the stenosis. The idea of the "recalibrage" is to remove only the upper part of the lamina with the ligamentum flavum and to cut the hypertrophied anterior part of the articular process from inside. If needed the disc and other osteophytes are removed. The surgery is finished with a ligamentoplasty reducing the flexion and preventing the extension by a posterior wedge.Our experience in spine surgery especially in scoliosis surgery, showed us that it was possible to cure a radicular compression without opening the canal. The compression is then lifted by the 3D reduction and restoration of an anatomy as normal as possible. Lumbar stenosis is the consequence of a degenerative process. Indeed, hip

  1. Radiological and functional outcome after anterior lumbar interbody spinal fusion.

    PubMed

    Christensen, F B; Karlsmose, B; Hansen, E S; Bünger, C E

    1996-01-01

    Outcome after anterior spinal fusion has mainly been studied radiologically and reported fusion rates vary greatly. The aim of this study was to investigate radiological and long-term clinical outcome. The study comprised 120 consecutive patients, operated on during the period 1979-1987, with single-or two-level anterior interbody spinal fusion due to disc degeneration or isthmic spondylolisthesis with lumbar instability. In 64 patients a supplemental facet joint fusion was performed. Clinical outcome was evaluated 5-13 years after surgery using the patient-administered Dallas Pain Questionnaire (DPQ). Radiological outcome was determined on the basis of radiographs taken at a 2-year follow-up assessed by independent observers. The radiological follow-up rate was 98%. Complete fusion was found in 52%, questionable fusion in 24%, and definitive pseudoarthrosis in 24% of patients. Radiological results were poor in patients who had undergone previous spinal surgery (P < 0.05) and in those with two-level fusion (P < 0.05). The DPQ reply rate was 80%. Sixty-six patients claimed improvement in all functional groups. Patients with complete or questionable union had significantly better results than did those with non-union (P < 0.01). Poorer functional outcome was found in patients who had undergone previous spinal surgery (P < 0.01) or fusion at the L4/L5 level (P < 0.05), in those who had responded poorly to the preoperative test brace (P < 0.05), and in those above 45 years old at the time of surgery (P < 0.05). Radiological and functional outcome did not vary according to whether patients were treated postoperatively with a plaster jacket or with facet screw fixation. The study demonstrated a functional success rate of approximately 66% following anterior lumbar spinal fusion after a mean follow-up of 8 years. There was a clear tendency for poorer prognosis for patients who had undergone previous spinal surgery, those aged above 45 years, those operated at the L4/L5

  2. Vascular Complications in Lumbar Spinal Surgery: Percutaneous Endovascular Treatment

    SciTech Connect

    Lee, Kyoung Ho; Park, Jae Hyung; Chung, Jin Wook; Han, Joon Koo; Shin, Sang Joon; Kang, Heung Sik

    2000-01-15

    Four patients underwent endovascular treatment of vascular injuries complicating lumbar spinal surgery. In two patients with massive retroperitoneal hemorrhage, the extravasating lumbar arteries were successfully embolized with microcoils. Two patients with large iliac arteriovenous fistula (AVF) were treated, one with embolization using a detachable balloon and coils, which failed, and the other with placement of a stent graft after embolization of distal runoff vessels, which occluded the fistula.We conclude that acute arterial laceration or delayed AVF complicating lumbar spinal surgery can be managed effectively with selective embolization or stent-graft placement, respectively.

  3. Lumbar spinal loads and muscle activity during a golf swing.

    PubMed

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

    2012-06-01

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

  4. Lumbar lordosis and sacral slope in lumbar spinal stenosis: standard values and measurement accuracy.

    PubMed

    Bredow, J; Oppermann, J; Scheyerer, M J; Gundlfinger, K; Neiss, W F; Budde, S; Floerkemeier, T; Eysel, P; Beyer, F

    2015-05-01

    Radiological study. To asses standard values, intra- and interobserver reliability and reproducibility of sacral slope (SS) and lumbar lordosis (LL) and the correlation of these parameters in patients with lumbar spinal stenosis (LSS). Anteroposterior and lateral X-rays of the lumbar spine of 102 patients with LSS were included in this retrospective, radiologic study. Measurements of SS and LL were carried out by five examiners. Intraobserver correlation and correlation between LL and SS were calculated with Pearson's r linear correlation coefficient and intraclass correlation coefficients (ICC) were calculated for inter- and intraobserver reliability. In addition, patients were examined in subgroups with respect to previous surgery and the current therapy. Lumbar lordosis averaged 45.6° (range 2.5°-74.9°; SD 14.2°), intraobserver correlation was between Pearson r = 0.93 and 0.98. The measurement of SS averaged 35.3° (range 13.8°-66.9°; SD 9.6°), intraobserver correlation was between Pearson r = 0.89 and 0.96. Intraobserver reliability ranged from 0.966 to 0.992 ICC in LL measurements and 0.944-0.983 ICC in SS measurements. There was an interobserver reliability ICC of 0.944 in LL and 0.990 in SS. Correlation between LL and SS averaged r = 0.79. No statistically significant differences were observed between the analyzed subgroups. Manual measurement of LL and SS in patients with LSS on lateral radiographs is easily performed with excellent intra- and interobserver reliability. Correlation between LL and SS is very high. Differences between patients with and without previous decompression were not statistically significant.

  5. Rehabilitation following surgery for lumbar spinal stenosis.

    PubMed

    McGregor, Alison H; Probyn, Katrin; Cro, Suzie; Doré, Caroline J; Burton, A Kim; Balagué, Federico; Pincus, Tamar; Fairbank, Jeremy

    2013-12-09

    Lumbar spinal stenosis is a common cause of back pain that can also give rise to pain in the buttock, thigh or leg, particularly when walking. Several possible treatments are available, of which surgery appears to be best at restoring function and reducing pain. Surgical outcome is not ideal, and a sizeable proportion of patients do not regain good function. No accepted evidence-based approach to postoperative care is known-a fact thathas prompted this review. To determine whether active rehabilitation programmes following primary surgery for lumbar spinal stenosis have an impact on functional outcomes and whether such programmes are superior to 'usual postoperative care'. We searched the following databases from their first issues to March 2013: CENTRAL (The Cochrane Library, most recent issue), the Cochrane Back Review Group Trials Register, MEDLINE, EMBASE, CINAHL and PEDro. We considered randomised controlled trials (RCTs) that compared the effectiveness of active rehabilitation versus usual care in adults (> 18 years of age) with confirmed lumbar spinal stenosis who had undergone spinal decompressive surgery (with or without fusion) for the first time. Two review authors independently extracted data from the included trials by using a predeveloped form. We contacted authors of original trials to request additional unpublished data as required. We recorded baseline characteristics of participants, interventions, comparisons, follow-up and outcome measures to enable assessment of clinical homogeneity. Clinical relevance was independently assessed by using the five questions recommended by the Cochrane Back Review Group (CBRG), and risk of bias within studies was determined by using CBRG criteria.We pooled individual study results in a meta-analysis when appropriate. For continuous outcomes, we calculated the mean difference (MD) when the same measurement scales were used in all studies and the standardised mean difference (SMD) when different measurement scales

  6. Protrusion of a rod into the spinal canal 10 years after segmental lumbar spine surgery.

    PubMed

    Cai, Siyi; Kong, Xiangyi; Yan, Chengrui; Wang, Yipeng; Wan, Xueshuai; Zhang, Jialu; Qiu, Guixing; Yu, Keyi

    2017-03-01

    The objective of this article is to report an unusual case of a spinal rod that protruded into the spinal canal after lumbar spine surgery.Only 4 cases of spinal rod migration with protrusion into the spinal canal have been reported. This is the first report of a case involving the use of posterior low lumbar segmental instrumentation with a screw-rod system. The left side of the rod gradually migrated and finally protruded into the canal and compressed the cord.A 60-year-old woman presented with pain and numbness of the posterior aspect of the left leg after a long-distance walk. Intermittent claudication became worse, and she developed pain and numbness in the perineal region. An x-ray showed that the left side of a spinal rod among the segmental spinal instruments that had been placed 10 years previously had protruded into the spinal canal.We removed the rod and decompressed the canal at the level of L5-S1. The patient became totally asymptomatic.Rods used as spinal instrumentation have the possibility of protruding into the spinal canal and endangering the nervous system. Long-term follow-up with radiological examinations should be conducted upon completion of spinal operations conducting using instrumentation.

  7. Protrusion of a rod into the spinal canal 10 years after segmental lumbar spine surgery

    PubMed Central

    Cai, Siyi; Kong, Xiangyi; Yan, Chengrui; Wang, Yipeng; Wan, Xueshuai; Zhang, Jialu; Qiu, Guixing; Yu, Keyi

    2017-01-01

    Abstract The objective of this article is to report an unusual case of a spinal rod that protruded into the spinal canal after lumbar spine surgery. Only 4 cases of spinal rod migration with protrusion into the spinal canal have been reported. This is the first report of a case involving the use of posterior low lumbar segmental instrumentation with a screw–rod system. The left side of the rod gradually migrated and finally protruded into the canal and compressed the cord. A 60-year-old woman presented with pain and numbness of the posterior aspect of the left leg after a long-distance walk. Intermittent claudication became worse, and she developed pain and numbness in the perineal region. An x-ray showed that the left side of a spinal rod among the segmental spinal instruments that had been placed 10 years previously had protruded into the spinal canal. We removed the rod and decompressed the canal at the level of L5-S1. The patient became totally asymptomatic. Rods used as spinal instrumentation have the possibility of protruding into the spinal canal and endangering the nervous system. Long-term follow-up with radiological examinations should be conducted upon completion of spinal operations conducting using instrumentation. PMID:28328849

  8. Microscopy-assisted interspinous tubular approach for lumbar spinal stenosis.

    PubMed

    Soriano-Sánchez, José-Antonio; Quillo-Olvera, Javier; Soriano-Solis, Sergio; Soriano-Lopez, Miroslava-Elizabeth; Covarrubias-Rosas, Claudia-Angélica; Quillo-Reséndiz, Javier; Gutiérrez-Partida, Carlos-Francisco; Rodríguez-García, Manuel

    2017-03-01

    Various minimally invasive techniques have been reported as an alternative to conventional lumbar decompression. The major advantage of these minimally invasive procedures lies in their reduction of unnecessary exposure and tissue trauma. Our objective was to describe a minimally invasive procedure for lumbar spinal stenosis decompression by enlarging the lumbar interspinous space, approaching it with a tubular retractor, and assisting with microscopy. Thoracolumbar fascia and paravertebral muscles are preserved throughout the whole procedure. Iatrogenic instability of the spine can be avoided if during the procedure both joints are just undercut in order to decompress the subarticular space. The approach described in this manuscript could be used as an alternate minimally invasive surgical procedure for the treatment of central and lateral lumbar spinal stenosis.

  9. Microscopy-assisted interspinous tubular approach for lumbar spinal stenosis

    PubMed Central

    Soriano-Sánchez, José-Antonio; Soriano-Solis, Sergio; Soriano-Lopez, Miroslava-Elizabeth; Covarrubias-Rosas, Claudia-Angélica; Quillo-Reséndiz, Javier; Gutiérrez-Partida, Carlos-Francisco; Rodríguez-García, Manuel

    2017-01-01

    Various minimally invasive techniques have been reported as an alternative to conventional lumbar decompression. The major advantage of these minimally invasive procedures lies in their reduction of unnecessary exposure and tissue trauma. Our objective was to describe a minimally invasive procedure for lumbar spinal stenosis decompression by enlarging the lumbar interspinous space, approaching it with a tubular retractor, and assisting with microscopy. Thoracolumbar fascia and paravertebral muscles are preserved throughout the whole procedure. Iatrogenic instability of the spine can be avoided if during the procedure both joints are just undercut in order to decompress the subarticular space. The approach described in this manuscript could be used as an alternate minimally invasive surgical procedure for the treatment of central and lateral lumbar spinal stenosis. PMID:28435920

  10. Extranodal Rosai-Dorfman disease with multilevel lumbar spinal lesions.

    PubMed

    Ma, Junming; Xiao, Jianru; Wang, Liangzhe

    2008-07-01

    The authors describe the case of a 44-year-old man with multilevel lumbar spinal Rosai-Dorfman disease (RDD), a rare clinical entity. To the authors' knowledge, there have been only 2 cases of lumbar spinal involvement of RDD (epidural) reported in the literature, and the current case is the third but the only one showing lumbar spinal intradural involvement of RDD. This case of RDD mimicked a meningioma both clinically and radiologically. The patient underwent a procedure in which the tumor was excised, and postoperatively the patient made a clinically acceptable recovery. Vertebral canal involvement of RDD should be considered in the differential diagnosis of vertebral canal tumors. Resection is an acceptable treatment option.

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

    PubMed Central

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

    2009-01-01

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

  12. Is epidural steroid injection effective for degenerative lumbar spinal stenosis?

    PubMed

    Flores, Sebastián; Molina, Marcelo

    2015-11-16

    There are several nonsurgical alternatives to treat radicular pain in degenerative lumbar spinal stenosis. Epidural steroid injections have been used for several decades, but the different studies have shown variable effects. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified nine systematic reviews including seven pertinent randomized controlled trials. We concluded epidural steroid injection probably leads to little or no effect on reducing radicular pain of spinal stenosis.

  13. Spinal Anesthesia in Elderly Patients Undergoing Lumbar Spine Surgery.

    PubMed

    Lessing, Noah L; Edwards, Charles C; Brown, Charles H; Ledford, Emily C; Dean, Clayton L; Lin, Charles; Edwards, Charles C

    2017-03-01

    Spinal anesthesia is increasingly viewed as a reasonable alternative to general anesthesia for lumbar spine surgery. However, the results of spinal anesthesia in elderly patients undergoing lumbar spine decompression and combined decompression and fusion procedures are limited in the literature. The aim of this study was to report a single institution's experience using spinal anesthesia in elderly patients undergoing lumbar spine surgery. A retrospective review was conducted using a prospectively collected database of consecutive lumbar spine surgeries performed under spinal anesthesia in patients 70 years or older at a single center between December 2013 and October 2015. A total of 56 patients were included in the study; 27 patients (48%) underwent lumbar decompression and 29 patients (52%) underwent combined decompression and fusion procedures. Mean operative time was 101 minutes (range, 30-210 minutes), and mean operative blood loss was 187 mL (range, 20-700 mL). Mean maximum inpatient postoperative visual analog scale score was 6.2 (range, 1-10). Nausea occurred in 21% (12 of 56) of the patients. Mean length of stay was 2.4 days (range, 1-6 days). No mortality, stroke, permanent loss of function, or pulmonary embolism occurred. None of the cases required conversion to general anesthesia. All of the patients were ambulatory on either the day of the surgery or the next morning. These results demonstrate that spinal anesthesia is a viable method of anesthesia for patients 70 years and older undergoing lumbar spine surgery. They also demonstrate the safety of this method for patients older than 84 years and for surgeries lasting up to 3½ hours. [Orthopedics. 2017; 40(2):e317-e322.].

  14. Idiopathic Spinal Epidural Lipomatosis in the Lumbar Spine.

    PubMed

    Al-Omari, Ali A; Phukan, Rishabh D; Leonard, Dana A; Herzog, Tyler L; Wood, Kirkham B; Bono, Christopher M

    2016-05-01

    Overgrowth of epidural fat, known as spinal epidural lipomatosis (SEL), can cause symptomatic compression of the spinal cord, conus medullaris, or cauda equina. Suggested predisposing factors such as obesity, steroid use, and diabetes mellitus have been based on a few reported cases, many of which were not surgically confirmed. There is a paucity of epidemiological data in surgically confirmed cases for this disorder. The purpose of this independently reviewed, retrospective, matched cohort analysis was to compare the demographics and incidence of comorbidities of patients who underwent lumbar decompression for SEL vs degenerative stenosis without SEL. Two surgeons' databases were reviewed to identify patients older than 18 years who underwent decompression surgery for magnetic resonance imaging-verified, symptomatic lumbar SEL. A matched control group comprised an equal number of patients with degenerative stenosis (n=14). Demographic data, body mass index, symptom type/duration, comorbidities, complications, treatment history, and associated pathology were collected from medical records. Previously suggested risk factors, such as obesity, endocrinopathy, and epidural steroid injections, were not significantly different between the SEL and control groups. Furthermore, there were no differences in operative times, complications, or blood loss. The only noted difference between the 2 groups was the preoperative duration of symptoms, on average double in patients with SEL. This series represents the largest of its kind reported to date. Because symptom duration was the only difference noted, it is postulated to be the result of lack of awareness of SEL. Future prospective study in a larger group of patients is warranted. [Orthopedics. 2016; 39(3):163-168.].

  15. A novel MRI classification system for congenital functional lumbar spinal stenosis predicts the risk for tandem cervical spinal stenosis.

    PubMed

    van Eck, Carola F; Spina Iii, Nicholas T; Lee, Joon Y

    2017-02-01

    The purpose of this study was to develop a simple and clinically useful morphological classification system for congenital lumbar spinal stenosis using sagittal MRI, allowing clinicians to recognize patterns of lumbar congenital stenosis quickly and be able to screen these patients for tandem cervical stenosis. Forty-four subjects with an MRI of both the cervical and lumbar spine were included. On the lumbar spine MRI, the sagittal canal morphology was classified as one of three types: Type I normal, Type II partially narrow, Type III globally narrow. For the cervical spine, the Torg-Pavlov ratio on X-ray and the cervical spinal canal width on MRI were measured. Kruskal-Wallis analysis was done to determine if there was a relationship between the sagittal morphology of the lumbar spinal canal and the presence of cervical spinal stenosis. Subjects with a type III globally narrow lumbar spinal canal had a significantly lower cervical Torg-Pavlov ratio and smaller cervical spinal canal width than those with a type I normal lumbar spinal canal. A type III lumbar spinal canal is a globally narrow canal characterized by a lack of spinal fluid around the conus. This was defined as "functional lumbar spinal stenosis" and is associated with an increased incidence of tandem cervical spinal stenosis.

  16. Lumbar Puncture (Spinal Tap) (For Parents)

    MedlinePlus

    ... treatment while waiting for the results of the culture. Risks A lumbar puncture is considered a safe procedure with minimal risks. Most of the time, there are no complications. In some instances, a ...

  17. Roseomonas spinal epidural abscess complicating instrumented posterior lumbar interbody fusion.

    PubMed

    Maraki, Sofia; Bantouna, Vasiliki; Lianoudakis, Efstratios; Stavrakakis, Ioannis; Scoulica, Efstathia

    2013-07-01

    The first case of a spinal epidural abscess caused by Roseomonas mucosa following instrumented posterior lumbar fusion is presented. Although rare, because of its highly resistant profile, Roseomonas species should be included in the differential diagnosis of epidural abscesses in both immunocompromised and immunocompetent hosts.

  18. Minimally invasive surgical decompression for lumbar spinal metastases

    PubMed Central

    Kimball, Jon; Kusnezov, Nicholas A.; Pezeshkian, Patrick; Lu, Daniel C.

    2013-01-01

    Background: The risk of significant morbidity and mortality often outweighs the benefit of surgical resection as palliative treatment for patients with high systemic disease burden, poor cardiopulmonary status, and previous spinal surgeries. Minimally invasive surgical (MIS) approaches to decompressing metastatic epidural cord compression (MECC) can address these issues and thereby make palliation a feasible option for these patients. Case Description: We present the cases of three consecutively collected patients with severe neurological compromise secondary to lumbar epidural metastases who underwent MIS decompression and achieved improved functional outcome and quality of life. The first patient is a 23-year-old female with metastatic Ewing's sarcoma who presented with 2 weeks of a right foot drop and radiculopathic pain. The next case is that of a 71-year-old male with metastatic prostate cancer who presented with significant radiculopathic L5-S1 pain and severe motor deficits in his lower extremities. The last case is that of a 73-year-old male with metastatic hepatocellular carcinoma who presented with worsening left leg weakness, paresthesia, and dysethesia. Postoperatively, each patient experienced significant improvement and almost complete enduring return of function, strength, and resolution of pain. Conclusion: We demonstrate that MIS approaches to spinal decompression as palliative treatment for metastatic disease is a viable treatment in patients with a focal symptomatic lesion and comes with the benefits of decreased surgical morbidity inherent to the minimally invasive approach as well as excellent functional outcomes. PMID:23869278

  19. Posture of patients with lumbar spinal canal stenosis.

    PubMed

    Truszczyńska, Aleksandra; Drzał-Grabiec, Justyna; Płszewski, Maciej; Rąpała, Kazimierz; Tarnowski, Adam

    2015-01-01

    The available literature is lacking in reports on the quantitative analysis of posture in patients with lumbar stenosis. The aim of this study was to analyze body posture in patients with lumbar spinal canal stenosis. The study involved 100 people: 49 persons with severe lumbar spine stenosis and 51 control subjects without any history of back pain. All participatants were evaluated by a photogrammetric method. Photogrammetric measurements showed statistically significant differences in the shape of the anterior-posterior curvatures of the spine. In the study group thoracic kyphosis was significantly greater (p = 0.043), and the depth of lumbar lordosis was significantly smaller (p = 0.038). The inclination of the thoracolumbar segment was also significantly lower (p = 0.013). 1. Measurements of body posture indicate a deepening of thoracic kyphosis and flattening of lumbar lordosis in lumbar stenosis patients. 2. Flattening of physiological lordosis seems to be caused by enlargment of the space of the spinal canal and dural sac in this position.

  20. A Framework for Patient-Specific Spinal Intervention Simulation: Application to Lumbar Spinal Durotomy Repair.

    PubMed

    Lau, Jonathan C; Denning, Lynn; Lownie, Stephen P; Peters, Terry M; Chen, Elvis C S

    2016-01-01

    We present a functional and patient-specific lumbar phantom for the training of spinal durotomy and dura closure under microscopic view, consisting of a lumbar model, pressurized dural surrogate, together immersed in a tissue-mimicking layer simulating fat, muscle and skin. The lumbar model was derived from a patient computed tomography scan, preserving the natural shape and curvature of the lumbar column. The inclusion of the simulated soft-tissue layer was critical for preserving the surgical ergonomics and presented a realistic view under the surgical microscope. As the success of dura repair is indicated by the watertight closure of the thecal sac, the dura surrogate was connected to a pressurized and closed-loop water system to provide functional cerebrospinal fluid leakage during durotomy. This functional phantom is inexpensive to construct, provides a realistic tactile and visual environment for spinal durotomy repair, and can be easily extended to simulate other patient-specific spinal interventions.

  1. Isolated lumbar intradural extra medullary spinal cysticercosis simulating tarlov cyst.

    PubMed

    Bansal, Sumit; Suri, Ashish; Sharma, Mehar Chand; Kakkar, Aanchal

    2017-01-01

    Spinal cysticercosis is a very uncommon manifestation of neurocysticercosis, which is caused by the larvae of Taenia solium. Here, we present a rare case of isolated lumbar intradural extramedullary neurocysticercosis, initially thought to be Tarlov cyst. A 40-year-old man, presented with low backache for 1-year with radiation of pain to right leg for 3 months. The patient was treated successfully with the surgical removal of the cyst, followed by medical treatment. Spinal neurocysticercosis should be considered in the differential diagnosis in high-risk populations, with new symptoms suggestive of a spinal mass lesion.

  2. Isolated lumbar intradural extra medullary spinal cysticercosis simulating tarlov cyst

    PubMed Central

    Bansal, Sumit; Suri, Ashish; Sharma, Mehar Chand; Kakkar, Aanchal

    2017-01-01

    Spinal cysticercosis is a very uncommon manifestation of neurocysticercosis, which is caused by the larvae of Taenia solium. Here, we present a rare case of isolated lumbar intradural extramedullary neurocysticercosis, initially thought to be Tarlov cyst. A 40-year-old man, presented with low backache for 1-year with radiation of pain to right leg for 3 months. The patient was treated successfully with the surgical removal of the cyst, followed by medical treatment. Spinal neurocysticercosis should be considered in the differential diagnosis in high-risk populations, with new symptoms suggestive of a spinal mass lesion. PMID:28484552

  3. LumbSten: The lumbar spinal stenosis outcome study

    PubMed Central

    2010-01-01

    Background Lumbar spinal stenosis is the most frequent reason for spinal surgery in elderly people. For patients with moderate or severe symptoms different conservative and surgical treatment modalities are recommended, but knowledge about the effectiveness, in particular of the conservative treatments, is scarce. There is some evidence that surgery improves outcome in about two thirds of the patients. The aims of this study are to derive and validate a prognostic prediction aid to estimate the probability of clinically relevant improvement after surgery and to gain more knowledge about the future course of patients treated by conservative treatment modalities. Methods/Design This is a prospective, multi-centre cohort study within four hospitals of Zurich, Switzerland. We will enroll patients with neurogenic claudication and lumbar spinal stenosis verified by Computer Tomography or Magnetic Resonance Imaging. Participating in the study will have no influence on treatment modality. Clinical data, including relevant prognostic data, will be collected at baseline and the Swiss Spinal Stenosis Questionnaire will be used to quantify severity of symptoms, physical function characteristics, and patient's satisfaction after treatment (primary outcome). Data on outcome will be collected 6 weeks, and 6, 12, 24 and 36 months after inclusion in the study. Applying multivariable statistical methods, a prediction rule to estimate the course after surgery will be derived. Discussion The ultimate goal of the study is to facilitate optimal, knowledge based and individualized treatment recommendations for patients with symptomatic lumbar spinal stenosis. PMID:21044326

  4. Lumbar Myeloid Cell Trafficking into Locomotor Networks after Thoracic Spinal Cord Injury

    PubMed Central

    Hansen, Christopher N.; Norden, Diana M.; Faw, Timothy D.; Deibert, Rochelle; S.Wohleb, Eric; Sheridan, John F.; P.Godbout, Jonathan; Basso, D. Michele

    2016-01-01

    Spinal cord injury (SCI) promotes inflammation along the neuroaxis that jeopardizes plasticity, intrinsic repair and recovery. While inflammation at the injury site is well-established, less is known within remote spinal networks. The presence of bone marrow-derived immune (myeloid) cells in these areas may further impede functional recovery. Previously, high levels of the gelatinase, matrix metalloproteinase-9 (MMP-9) occurred within the lumbar enlargement after thoracic SCI and impeded activity-dependent recovery. Since SCI-induced MMP-9 potentially increases vascular permeability, myeloid cell infiltration may drive inflammatory toxicity in locomotor networks. Therefore, we examined neurovascular reactivity and myeloid cell infiltration in the lumbar cord after thoracic SCI. We show evidence of region-specific recruitment of myeloid cells into the lumbar but not cervical region. Myeloid infiltration occurred with concomitant increases in chemoattractants (CCL2) and cell adhesion molecules (ICAM-1) around lumbar vasculature 24 hours and 7 days post injury. Bone marrow GFP chimeric mice established robust infiltration of bone marrow-derived myeloid cells into the lumbar gray matter 24 hours after SCI. This cell infiltration occurred when the blood-spinal cord barrier was intact, suggesting active recruitment across the endothelium. Myeloid cells persisted as ramified macrophages at 7 days post injury in parallel with increased inhibitory GAD67 labeling. Importantly, macrophage infiltration required MMP-9. PMID:27191729

  5. Lumbar Myeloid Cell Trafficking into Locomotor Networks after Thoracic Spinal Cord Injury.

    PubMed

    Hansen, Christopher N; Norden, Diana M; Faw, Timothy D; Deibert, Rochelle; Wohleb, Eric S; Sheridan, John F; Godbout, Jonathan P; Basso, D Michele

    2016-08-01

    Spinal cord injury (SCI) promotes inflammation along the neuroaxis that jeopardizes plasticity, intrinsic repair and recovery. While inflammation at the injury site is well-established, less is known within remote spinal networks. The presence of bone marrow-derived immune (myeloid) cells in these areas may further impede functional recovery. Previously, high levels of the gelatinase, matrix metalloproteinase-9 (MMP-9) occurred within the lumbar enlargement after thoracic SCI and impeded activity-dependent recovery. Since SCI-induced MMP-9 potentially increases vascular permeability, myeloid cell infiltration may drive inflammatory toxicity in locomotor networks. Therefore, we examined neurovascular reactivity and myeloid cell infiltration in the lumbar cord after thoracic SCI. We show evidence of region-specific recruitment of myeloid cells into the lumbar but not cervical region. Myeloid infiltration occurred with concomitant increases in chemoattractants (CCL2) and cell adhesion molecules (ICAM-1) around lumbar vasculature 24h and 7days post injury. Bone marrow GFP chimeric mice established robust infiltration of bone marrow-derived myeloid cells into the lumbar gray matter 24h after SCI. This cell infiltration occurred when the blood-spinal cord barrier was intact, suggesting active recruitment across the endothelium. Myeloid cells persisted as ramified macrophages at 7days post injury in parallel with increased inhibitory GAD67 labeling. Importantly, macrophage infiltration required MMP-9.

  6. [Percutaneous interspinous distraction for the treatment of dynamic lumbar spinal stenosis and low back pain].

    PubMed

    Mayer, H Michael; Zentz, Florian; Siepe, Christoph; Korge, Andreas

    2010-11-01

    SURGICAL GOAL: Surgical treatment of dynamic lumbar spinal stenosis and discogenic/arthrogenic low back pain with a new percutaneous interspinous spacer as a therapeutic alternative to more invasive standard procedures. Central, lateral and foraminal dynamic lumbar spinal stenosis. Discogenic and arthrogenic (facet osteoarthritis) low back pain. Symptomatic, segmental hyperlordosis. Disc degeneration with dynamic (reducible) retrolisthesis. Interspinous pain ('Kissing-Spines'). Osteoporosis. Conus-/Cauda-syndrome. Structural spinal stenosis. Spondylolisthesis (degenerative and/or isthmic). Deformities. Previous posterior operation in index segment. Percutaneous, minimally invasive implantation of an interspinous spacer (InSpace ™, Synthes, Oberdorf, Switzerland). Early unrestricted mobilization. Good early results (after 2 year follow-up) in 42 patients with 76% subjective patient satisfaction rate. No approach related complications. Avoidance of the more invasive alternative procedure (decompression, fusion, total disc replacement) in 76.2% of the patients.

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

    PubMed

    Hu, Boyi; Ning, Xiaopeng

    2015-09-01

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

  8. Lumbar Lordosis of Spinal Stenosis Patients during Intraoperative Prone Positioning

    PubMed Central

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

    2016-01-01

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

  9. Lumbar Puncture (Spinal Tap) (For Parents)

    MedlinePlus

    ... anesthesia medication is given, a numbing cream is applied to the skin to minimize discomfort. The spinal ... Collected samples are sent to a lab for analysis and testing. Sometimes doctors also measure the amount ...

  10. Percutaneous radiofrequency rhizotomy of lumbar spinal facets: the results of 46 cases.

    PubMed

    Göçer, A I; Cetinalp, E; Tuna, M; Ildan, F; Bağdatoğlu, H; Haciyakupoğlu, S

    1997-01-01

    The results of percutaneous radiofrequency rhizotomy of lumbar spinal facets in 46 patients followed at least three months (mean 15 months) are reported and compared with those reported previously. Satisfactory pain relief three months after the procedure was achieved in 36.4 percent of patients without operations and in 41.7 percent of patients, with operations other than fusion. No patient had previously undergone fusion. Treatment of low-back pain by using radio-frequency thermocoagulation of spinal facets is a simple, safe, and well-tolerated procedure. It can be used to relief of pain in spite of decreasing rates of success within the follow-up period.

  11. Rapidly Progressive Gas-containing Lumbar Spinal Epidural Abscess

    PubMed Central

    Bang, Jin Hyuk

    2015-01-01

    Gas-containing (emphysematous) infections of the abdomen, pelvis, and extremities are well-known disease entities, which can potentially be life-threatening. They require aggressive medical and often surgical treatment. In the neurosurgical field, some cases of gas-containing brain abscess and subdural empyema have been reported. Sometimes they progress rapidly and even can cause fatal outcome. However, gas-containing spinal epidural abscess has been rarely reported and clinical course is unknown. We report on a case of rapidly progressive gas-containing lumbar spinal epidural abscess due to Enterococcus faecalis in a 72-year-old male patient with diabetes mellitus. PMID:26512268

  12. Rapidly Progressive Gas-containing Lumbar Spinal Epidural Abscess.

    PubMed

    Bang, Jin Hyuk; Cho, Keun-Tae

    2015-09-01

    Gas-containing (emphysematous) infections of the abdomen, pelvis, and extremities are well-known disease entities, which can potentially be life-threatening. They require aggressive medical and often surgical treatment. In the neurosurgical field, some cases of gas-containing brain abscess and subdural empyema have been reported. Sometimes they progress rapidly and even can cause fatal outcome. However, gas-containing spinal epidural abscess has been rarely reported and clinical course is unknown. We report on a case of rapidly progressive gas-containing lumbar spinal epidural abscess due to Enterococcus faecalis in a 72-year-old male patient with diabetes mellitus.

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

    PubMed Central

    Hasankhani, Ebrahim Ghayem; Ashjazadeh, Amir

    2014-01-01

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

  14. MIS Fusion of the SI Joint: Does Prior Lumbar Spinal Fusion Affect Patient Outcomes?

    PubMed

    Rudolf, Leonard

    2013-01-01

    Sacroiliac (SI) joint pain is a challenging condition to manage as it can mimic discogenic or radicular low back pain, and present as low back, hip, groin and/or buttock pain. Patients may present with a combination of lumbar spine and SI joint symptoms, further complicating the diagnosis and treatment algorithm [1-3]. SI joint pain after lumbar spinal fusion has been reported in the literature. Both clinical and biomechanical studies show the SI joint to be susceptible to increased motion and stress at the articular surface with up to 40-75% of patients developing significant SI joint degeneration after 5 years. In a recent case series study of 50 patients who underwent minimally invasive SI joint arthrodesis, 50% had undergone previous lumbar spinal fusion and 18% had symptomatic lumbar spine pathology treated conservatively [4]. The purpose of this study is to determine if history of previous lumbar fusion or lumbar pathology affects patient outcomes after MIS SI joint fusion surgery. We report on 40 patients with 24 month follow up treated with MIS SI joint fusion using a series of triangular porous plasma coated titanium implants (iFuse, SI-Bone, Inc. San Jose, CA). Outcomes using a numerical rating scale (NRS) for pain were obtained at 3-, 6-, 12- and 24 month follow up intervals. Additionally, patient satisfaction was collected at the latest follow up interval. Patients were separated into 3 cohorts: 1) underwent prior lumbar spine fusion (PF), 2) no history of previous lumbar spine fusion (NF), 3) no history of previous lumbar spine fusion with symptomatic lumbar spine pathology treated conservatively (LP). A repeated measures analysis of variance (rANOVA) was used to determine if the change in NRS pain scores differed across timepoints and subgroups. A decrease in NRS by 2 points was deemed clinically significant [5]. Mean age was 54 (±13) years and varied slightly but not statistically between groups. All subgroups experienced a clinically and

  15. The association of spinal osteoarthritis with lumbar lordosis

    PubMed Central

    2010-01-01

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

  16. The association of spinal osteoarthritis with lumbar lordosis.

    PubMed

    Papadakis, Michael; Papadokostakis, Georgios; Kampanis, Nikos; Sapkas, Georgios; Papadakis, Stamatios A; Katonis, Pavlos

    2010-01-02

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

  17. Amyloid deposits derived from transthyretin in the ligamentum flavum as related to lumbar spinal canal stenosis.

    PubMed

    Yanagisawa, Akihiro; Ueda, Mitsuharu; Sueyoshi, Takanao; Okada, Tatsuya; Fujimoto, Toru; Ogi, Yasuhiro; Kitagawa, Keisuke; Tasaki, Masayoshi; Misumi, Yohei; Oshima, Toshinori; Jono, Hirofumi; Obayashi, Konen; Hirakawa, Kei; Uchida, Hitoshi; Westermark, Per; Ando, Yukio; Mizuta, Hiroshi

    2015-02-01

    Amyloidosis is a protein conformational disorder with the distinctive feature of extracellular accumulation of amyloid fibrils that come from different proteins. In the ligamentum flavum of the lumbar spine, amyloid deposits were frequently found in elderly patients with lumbar spinal canal stenosis and were at least partially formed by wild-type transthyretin. However, how amyloid deposits in the ligamentum flavum affect lumbar spinal canal stenosis has remained unclear. In this study, we analyzed clinical, pathologic, and radiologic findings of patients with lumbar spinal canal stenosis who had amyloid deposits in the ligamentum flavum. We studied 95 ligamentum flavum specimens obtained from 56 patients with lumbar spinal canal stenosis and 21 ligamentum flavum specimens obtained from 19 patients with lumbar disk herniation. We evaluated histopathologic findings and clinicoradiologic manifestations, such as thickness of the ligamentum flavum and lumbar spinal segmental instability. We found that all 95 ligamentum flavum specimens resected from patients with lumbar spinal canal stenosis had amyloid deposits, which we classified into two types, transthyretin-positive and transthyretin-negative, and that transthyretin amyloid formation in the ligamentum flavum of patients with lumbar spinal canal stenosis was an age-associated phenomenon. The amount of amyloid in the ligamentum flavum was related to clinical manifestations of lumbar spinal canal stenosis, such as thickness of the ligamentum flavum and lumbar spinal segmental instability, in the patients with lumbar spinal canal stenosis with transthyretin-positive amyloid deposits. To our knowledge, this report is the first to show clinicopathologic correlations in transthyretin amyloid deposits of the ligamentum flavum. In conclusion, transthyretin amyloid deposits in the ligamentum flavum may be related to the pathogenesis of lumbar spinal canal stenosis in elderly patients.

  18. Symptomatic lumbar spinal arachnoiditis: fact or fallacy?

    PubMed

    Petty, P G; Hudgson, P; Hare, W S

    2000-09-01

    It is generally accepted that chronic adhesive lumbar arachnoiditis is a cause of symptoms, notably back pain and/or pain (of almost any type, not necessarily 'anatomical') in the lower limbs, although there is no clearly defined clinical pattern which is clearly associated with this syndrome. There is no doubt that arachnoiditis occurs as a pathological and radiological entity due to a number of causes. In the view of the present authors, the nexus between the pathology and radiology on the one hand, and the patients' symptoms on the other hand, has not been demonstrated with any degree of scientific rigor.

  19. Targeted Intraspinal Radiofrequency Ablation for Lumbar Spinal Stenosis.

    PubMed

    Jacobson, Robert E; Granville, Michelle; Hatgis DO, Jesse

    2017-03-10

    By using a combination of magnetic resonance imaging (MRI) and computed tomography (CT) of the lumbar spine, it is possible to distinguish between spinal stenosis caused by bone compression and specific soft tissue epidural intraspinal lesions that cause localized spinal canal stenosis and neural compression. Examples include facet cysts and yellow ligament hypertrophy. Many of these patients are elderly with medical comorbidities that make open surgery problematic. This is a study of patients with predominantly soft tissue stenosis being treated with targeted intraspinal radiofrequency (RF) heat ablation. This novel procedure is performed under local anesthesia in an outpatient setting using intra-operative imaging. Fine tip 20 gauge RF electrodes (Stryker® PA, USA) are precisely placed under radiologic guidance in the identified soft tissue causing the posterior compression of the lumbar spinal canal. After sensory and motor testing to make sure there is a safe distance of the needle tip from the nearby nerve roots to avoid any neural effect, multiple targeted lesions correlated by the MRI or CT scan are made in the fibrous and cystic soft tissue. Lesions are created using a focused 2 or 5 mm tip at 60 degrees centigrade (°C) for either 30 or 60 seconds. This heat causes sufficient shrinking of the targeted soft tissue resulting in relative reduction of the soft tissue component of the stenosis. This relative reduction in the stenosis of the spinal canal, similar to that measured with interspinous devices, provides long-term relief of symptoms, signs, and improvement of spinal motion in patients with lumbar stenosis. This report will review the spinal anatomy, and development and history of using RF in and around the nerve roots and epidural space, as it relates to lumbar stenosis. Examples of before and after MRI scans demonstrate the radiologic reduction in the size of the lesions. This soft tissue reduction correlates with patients' improvement in pain

  20. Targeted Intraspinal Radiofrequency Ablation for Lumbar Spinal Stenosis

    PubMed Central

    Jacobson, Robert E; Hatgis, DO, Jesse

    2017-01-01

    Introduction By using a combination of magnetic resonance imaging (MRI) and computed tomography (CT) of the lumbar spine, it is possible to distinguish between spinal stenosis caused by bone compression and specific soft tissue epidural intraspinal lesions that cause localized spinal canal stenosis and neural compression. Examples include facet cysts and yellow ligament hypertrophy. Many of these patients are elderly with medical comorbidities that make open surgery problematic. Materials & Methods This is a study of patients with predominantly soft tissue stenosis being treated with targeted intraspinal radiofrequency (RF) heat ablation. This novel procedure is performed under local anesthesia in an outpatient setting using intra-operative imaging. Fine tip 20 gauge RF electrodes (Stryker® PA, USA) are precisely placed under radiologic guidance in the identified soft tissue causing the posterior compression of the lumbar spinal canal. After sensory and motor testing to make sure there is a safe distance of the needle tip from the nearby nerve roots to avoid any neural effect, multiple targeted lesions correlated by the MRI or CT scan are made in the fibrous and cystic soft tissue. Lesions are created using a focused 2 or 5 mm tip at 60 degrees centigrade (°C) for either 30 or 60 seconds. This heat causes sufficient shrinking of the targeted soft tissue resulting in relative reduction of the soft tissue component of the stenosis. This relative reduction in the stenosis of the spinal canal, similar to that measured with interspinous devices, provides long-term relief of symptoms, signs, and improvement of spinal motion in patients with lumbar stenosis. This report will review the spinal anatomy, and development and history of using RF in and around the nerve roots and epidural space, as it relates to lumbar stenosis. Examples of before and after MRI scans demonstrate the radiologic reduction in the size of the lesions. This soft tissue reduction correlates

  1. Correlation between severity of lumbar spinal stenosis and lumbar epidural steroid injection.

    PubMed

    Park, Chan-Hong; Lee, Sang-Ho

    2014-04-01

    Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal that causes mechanical compression of the spinal nerve roots. The compression of these nerve roots can cause leg pain, as well as neurogenic claudication. Lumbar epidural steroid injections have commonly been used in patients with LSS. The aim of our study was to determine the relationship between the severity of LSS using a grading system (grade 1 = mild stenosis with separation of all cauda equina; grade 2 = moderate stenosis with some cauda equina aggregated; grade 3 = severe stenosis with none of the cauda equina separated) and the subject's response to computed tomography-guided lumbar epidural steroid injection (CTG-LESI) and to evaluate the short-term effectiveness. Forty-seven consecutive patients with degenerative LSS were enrolled in this prospective study. All subjects underwent lumbar spine magnetic resonance imaging. Two radiologists independently graded lumbar central canal stenosis based on T2-weighted axial images. All CTG-LESI were performed in the procedure room. Outcome measures were obtained using the 5-point patient's satisfaction scale at 2 and 8 weeks post-treatment. To evaluate the outcome, we divided the patients into two groups according to their response to the treatment. Improvement (including reports of slightly improved, much improved, and no pain) was observed in 37 patients (78.7%) at 2 weeks and 36 patients (77.6%) at 8 weeks after the procedure. There was no statistically significant correlation between pain relief and age. The grade of LSS appears to have no effect on the degree of pain relief associated with CTG-LESI. However, CTG-LESI seems to provide effective short-term pain relief due to LSS. Wiley Periodicals, Inc.

  2. Spinal sagittal balance and spinopelvic parameters in patients with degenerative lumbar spinal stenosis; a comparative study.

    PubMed

    Farrokhi, Majid Reza; Haghnegahdar, Ali; Rezaee, Hamid; Sharifi Rad, Mohammad Reza

    2016-12-01

    This study aims to evaluate the spinal sagittal balance and the spinopelvic parameters in patients with degenerative lumbar spinal stenosis and healthy controls in Iranian population. We performed a case-control study in which 48 patients with lumbar spine stenosis and 54 age- and sex-matched healthy subjects with back pain were eligible for participation. We used INFINITT picture archiving and communication systems (PACS) of the Chamran Hospital for selecting the patients for the study group. The sagittal balance, pelvic incidence, lumbar lordosis, and sacral slope were measured in all the patients and controls using thoracolumbosacral radiographies in the standing position. There was no significant difference between the 2 groups regarding the baseline characteristics. The prevalence of sagittal imbalance was significantly higher in the patients with lumbar spine stenosis in comparison with the controls (31.2% vs. 14.8%; P<0.001). The sacral slope was significantly lower in patients with lumbar canal stenosis than the healthy controls (31.39°±11.2 vs. 43.7°±8.4; P<0.001). The lumbar lordosis was significantly lower in patients with lumbar canal stenosis than the controls (31.27°±12.4 vs. 45.8°±10.7; P < 0.001). The pelvic incidence was not significantly different between the 2 groups (50.16°±11.9 vs. 52°±9.6; P=0.342). The degenerative lumbar canal stenosis is associated with increased sagittal imbalance and decreased lumbar lordosis and sacral slope in a sample of the Iranian adult population. Copyright © 2016 Elsevier B.V. All rights reserved.

  3. Diagnostic value of cauda equina motor conduction time in lumbar spinal stenosis.

    PubMed

    Seçil, Yaprak; Ekinci, Ayşen Süzen; Bayram, Korhan Barış; Incesu, Tülay Kurt; Tokuçoğlu, Figen; Gürgör, Nevin; Özdemirkıran, Tolga; Başoğlu, Mustafa; Ertekin, Cumhur

    2012-09-01

    Lumbar spinal stenosis (LSS) is a chronic degenerative disease with pain in the back, buttocks and legs aggrevated by walking and relieved after rest without associated vascular disease of lower extremities observed in patients between 50 and 60 years. Several studies, using different methods indicated an association between slowing or blocking of root-nerve conduction and LSS. None of the previous research had applied the more conceivable methods such as recording the cauda equina potentials from the lumbar level or stimulating the spinal roots within the canal using either leg nerves or muscles. In this study, electrical lumbar laminar stimulation was used to demonstrate prolongation of cauda equina motor conduction time in lumbar spinal stenosis. Twenty-one LSS patients and age matched 15 normal control subjects were included in the study. Lumbar laminar electrical stimulation from L1 and L5 vertebra levels were applied by needle electrodes. Compound muscle action potential (CMAP) from gastrocnemius muscles were recorded bilaterally. Latency difference of CMAPs obtained from L1 and L5 spine levels were accepted as the cauda equina motor conduction time (CEMCT). CEMCT was significantly longer in patient group when compared to normal controls. Mean latency difference was 3.59 ± 1.07 msec on the right side, 3.49 ± 1.07 msec on the left side in LSS group, it was 1.45 ± 0.65 msec on the right side, 1.35 ± 0.68 msec on the left side on normal control group (p<0.0001). The prolongation of CEMCT was statistically and individually significant in patient group. This may indicate that lower lumbosacral motor roots were locally and chronically compressed due to lumbar spinal stenosis. Lumbar spinal stenosis may have induced local demyelination at the cauda equina level. Since the prolongation of CEMCT was found only in patients with LSS, the method of laminar stimulation can be chosen for patients with uncertain diagnosis of LSS. Copyright © 2012 International

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

    PubMed Central

    Makirov, Serik K.; Osadchiy, Valentin

    2015-01-01

    Background Lumbar spinal stenosis is a pathological condition of the spinal channel with its concentric narrowing with presence of specific clinical syndrome. Absence of the clear unified radiological signs is the one of the basic problems of the lumbar spinal stenosis. Purpose The authors seek to create method of assessment of the spinal canal narrowing degree, based on anatomical aspects of lumbar spinal stenosis. Study Design Development of diagnostic criteria based on analysis of a consecutive patients group and a control group. Methods Thirty seven patients (73 stenotic segments) with mean age 62,4 years old were involved in the study. Severity of clinical symptoms has been estimated by the measuring scales: Oswestry Disability Index (ODI) and Swiss Spinal Stenosis Questionnaire (SSQ). Mean number of the stenotic segments was 1.97. For all patients 8 radiological criteria have been measured. In the control group have been included 37 randomly selected patients (volunteers) in mean age of 53,4 years old without stenosis signs and narrowing of the spinal canal on the MRI imaging (73 segments total). Measurements were performed at the middle of intervertebral disc and facet joints level. Results For description of the state of spinal canal we offer the coefficient: ratio of the lateral canals total area to the cross-sectional area of the dural sac (“coefficient of stenosis”). Comparison of mean values of “coefficient of stenosis” for main and control groups showed statistically significant differences (t = -12,5; p < 0.0001). Strong statistically significant correlation with the ODI and SSS scales was revealed for the obtained coefficient (p <0.05). Conclusions In our study new method of assessment of the spinal canal narrowing degree has been applied. Promising results have been obtained in a small group of patients. It is necessary to check the data on a large sample of recommendations for its clinical application. PMID:25834777

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

    PubMed

    Hughes, Andrew; Makirov, Serik K; Osadchiy, Valentin

    2015-01-01

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

  6. Spinal epidural lipomatosis in lumbar magnetic resonance imaging scans.

    PubMed

    Sugaya, Hisashi; Tanaka, Toshikazu; Ogawa, Takeshi; Mishima, Hajime

    2014-04-01

    The goal of this study was to quantify the frequency of advanced spinal epidural lipomatosis (SEL) detected on lumbar magnetic resonance imaging (MRI) scans performed at the authors' hospital and to compare the frequency, cause, and progression of SEL in these cases with that reported in the literature. The total number of MRI examinations of the lumbar spine performed at this hospital over 45 months was 1498 (705 men and 793 women; mean age, 60.3 years). After the MRI data were reduced (T1- and T2-weighted sagittal and axial images) on the basis of the exclusion criteria, the anterior and posterior diameters of the dural sac and spinal canal were measured, as well as the thickness of the epidural fat. On the basis of these parameters, the severity of SEL was classified as grade 0 to grade III. Five cases of grade III SEL were diagnosed. The frequency of grade III SEL noted in this study was 0.33% (5/1498). Obesity (body mass index greater than 27.5) was noted in 3 cases, and the use of exogenous corticosteroids was noted in 3 cases. Exogenous steroid usage associated with advanced SEL in this study was greater than that reported in the literature. Most symptoms of SEL progress slowly, and early diagnosis allows for a dose reduction of the prescribed steroids. Thus, lumbar MRI examinations should be conducted aggressively in patients with exogenous steroid use and presenting with low back pain or buttock pain. Copyright 2014, SLACK Incorporated.

  7. Clinical usefulness of assessing lumbar somatosensory evoked potentials in lumbar spinal stenosis. Clinical article.

    PubMed

    Liu, Xinyu; Konno, Shunsuke; Miyamoto, Masabumi; Gembun, Yoshikazu; Horiguchi, Gen; Ito, Hiromoto

    2009-07-01

    The aim of this retrospective study was to evaluate the clinical usefulness of assessing lumbar somatosensory evoked potentials (SSEPs) in central lumbar spinal stenosis (LSS). The latencies of lumbar SSEPs were recorded in 40 patients with central LSS, including 16 men and 24 women. The mean age of the patients was 67.3 +/- 7.4 years. The diagnosis was LSS in 23 cases and LSS associated with degenerative spondylolisthesis in 17 cases. The average duration of symptoms was 43.8 +/- 51.2 months. Twenty-two cases had bilateral and 18 cases had unilateral leg symptoms. Thirty-seven cases were associated with neurogenic intermittent claudication and the mean walking distance of patients with this condition was 246.8 +/- 232.7 m. The mean Japanese Orthopedic Association scale score, as well as the visual analog scale (VAS) scores of low-back pain, leg pain, and numbness, were 16.5 +/- 3.5, 6.0 +/- 2.5, 6.9 +/- 2.1, and 7.8 +/- 2.2, respectively. The minimal cross-sectional area of the dural sac on MR imaging was 0.44 +/- 0.21 cm(2). Thirty-nine cases of cervical spondylotic myelopathy without lumbar and peripheral neuropathy were chosen as the control group. The latencies of lumbar SSEPs in patients with LSS and in the control group were 23.0 +/- 2.0 ms and 21.6 +/- 1.9 ms, respectively. There was a statistically significant difference between the LSS and control groups (p < 0.05). The latency of lumbar SSEPs was significant correlated with the VAS score of leg numbness (p < 0.05). The latency of lumbar SSEPs in LSS was clearly delayed when the VAS score of leg numbness was > or = 8 (p < 0.05). Lumbar SSEPs are able to detect neurological deficit in the lumbar area effectively, and they can reflect part of the subjective severity of sensory disturbance (numbness) in LSS. Both lumbar SSEPs and VAS scores of leg numbness may be useful for clinical evaluation in patients with LSS.

  8. Lumbar spinal chondroma presenting with acute sciatica.

    PubMed

    Kim, Dong Hwan; Nam, Kyoung Hyup; Choi, Byung Kwan; Han, Inho

    2013-12-01

    A 47-year-old woman visited with lumbago and severe left leg pain that had been presented for 1 week. The patient complained of severe radiating pain on left L3 sensory dermatome area and reported aggravation of leg pain at 20 degrees of hip flexion by straight leg raising test (SLRT). However, there was no motor weakness on neurological examination. Magnetic resonance imaging (MRI) demonstrated contrast enhancing spinal extradural mass at L2-3 level that was iso-signal intensity (SI) on T1-weighted images (WI), hypo-SI on T2WI. She was not able to walk and sleep due to incapacitating pain. Thus, surgical removal was performed via left partial laminectomy. Postoperatively, the radiating pain was relieved completely. Histopathologic examination revealed that the tumor consisted of chondroma, which had mature hyaline cartilage with nests of benign-appearing cells and calcium deposits in lacunae.

  9. A Rare Case of Pediatric Lumbar Spinal Ependymoma Mimicking Meningitis.

    PubMed

    Ekuma, Ezeali Mike; Ito, Kiyoshi; Chiba, Akihiro; Hara, Yosuke; Kanaya, Kohei; Horiuchi, Tetsuyoshi; Ohaegbulam, Samuel; Hongo, Kazuhiro

    2017-04-01

    Spontaneous acute subarachnoid hemorrhage (SAH) from lumbar ependymoma in children is rare. We report a case of a 14-year-old boy who developed sudden radicular low back pain while playing baseball. He was initially managed conservatively in a local hospital for suspected lumbar disc herniation, but he later developed meningeal symptoms and fever before being referred to our hospital. He underwent a diagnostic lumbar puncture in the emergency department; his cerebrospinal fluid suggested an SAH. Physical examination showed meningeal signs and cauda equina features. Cerebrospinal fluid analysis was negative for bacterial meningitis. Lumbar magnetic resonance imaging revealed a mass characterized as a hemorrhagic lesion. The patient had an emergent evacuation of the mass through the posterior approach. Postoperatively, his symptoms resolved completely. The histologic diagnosis was, surprisingly, an ependymoma (World Health Organization grade II). This case is particularly interesting because of its rarity in children, and its pattern of presentation. Although bacterial or viral meningitis is the most frequent cause of meningeal features in children, SAH from a hemorrhagic spinal tumor should be considered. Ultimately, a high index of suspicion is needed for prompt diagnosis. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Static balance after surgical decompression of lumbar spinal canal stenosis.

    PubMed

    Truszczyńska, Aleksandra; Drzał-Grabiec, Justyna; Trzaskoma, Zbigniew; Rachwał, Maciej; Rapała, Kazimierz; Górniak, Krystyna

    2015-01-01

    Spinal canal stenosis is the most common reason for spinal surgeries in patients over 65 years of age. The aim of the study was to assess static balance in patients prior to and after surgical decompression of lumbar spinal canal stenosis. The study population consisted of 30 patients suffering from spinal canal stenosis. Their static balance was measured, i.e. quantitative analysis of balance reaction parameters in quiet standing was performed. The analysis of the collected data did not reveal any statistically significant differences between parameters measured prior to and after the surgery (for p< 0.05). A tendency for a decrease of measured parameters was observed. The regularity of changes was determined; in addition, for this analysis, the Spearman's rank correlation coefficient was used. The analysis of the collected data did not reveal any statistically significant improvement of balance reactions after spinal canal stenosis surgery. In spite of pain reduction, there was no improvement in balance reactions, as behavioural patterns for balance reactions had been fossilised before surgery.

  11. Spinal anesthesia for laparoscopic cholecystectomy: Thoracic vs. Lumbar Technique

    PubMed Central

    Imbelloni, Luiz Eduardo

    2014-01-01

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

  12. Biportal Endoscopic Lumbar Decompression for Lumbar Disk Herniation and Spinal Canal Stenosis: A Technical Note.

    PubMed

    Eun, Sang Soo; Eum, Jin Hwa; Lee, Sang Ho; Sabal, Luigi Andrew

    2017-07-01

    Background and Study Aims Endoscopic lumbar diskectomy through the interlaminar window is gaining recognition. Most of the literature describes these endoscopic procedures using specialized uniportal multichannel endoscopes. However, a single portal limits the motion of the instruments and obscures visualization of the operating field. To overcome this limitation, we propose a new technique that utilizes two portals to access the spinal canal. The biportal endoscopic lumbar decompression (BELD) technique uses two portals to treat difficult lumbar disk herniations and also lumbar spinal stenoses. Patients and Methods Seventeen patients were treated with BELD for 11 lumbar disk herniations and 6 lumbar spinal stenoses. Preoperative back and leg visual analog scale (VAS-B and VAS-L, respectively) scores and the Oswestry Disability Index (ODI) were recorded and compared with corresponding values on final follow-up. Results There was an average follow-up of 14 months. For the disk herniation group, preoperative VAS-L (7.8750 ± 1.24) and ODI (51.73 ± 18.57) was significantly different from follow-up postoperative VAS-L (0.87 ± 0.64, p = 0.000) and ODI (9.37 ± 4.83, p = 0.001). For the stenosis group, preoperative VAS-B (6.17 ± 1.94), VAS-L(7.83 ± 1.47), and ODI (63.27 ± 7.67) were significantly different from follow-up postoperative values (2.5 ± 1.04, p = 0.022; 2.00 ± 1.67, p = 0.001; 24.00 ± 6.45, p = 0.000, respectively). One patient underwent revision microdiskectomy for incomplete decompression. Conclusions BELD can achieve a similar decompression effect as microdiskectomy and unilateral laminotomy for bilateral decompression with a smaller incision than tubular diskectomy. Georg Thieme Verlag KG Stuttgart · New York.

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

    PubMed

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

    2014-08-01

    To explore the surgical indications, decompression and fusion method, and fusion level selection of degenerative lumbar scoliosis (DLS) and multi-segment lumbar spinal stenosis. Between April 2000 and November 2011, 46 cases of DLS and multi-segment lumbar spinal stenosis were treated with multi-level decompression by fenestration and crept enlargement plus internal fixation by interbody and posterior-lateral bone graft fusion (5 segments or above). Of 46 cases, 25 were male and 21 were female, with a mean age of 70.2 years (range, 65-81 years) and with a mean disease duration of 6.4 years (range, 4 years and 6 months to 13 years). X-ray films showed that the lumbar Cobb angle was (26.7 ± 10.0) degrees, and the lumbar lordotic angle was (20.3 ± 8.8)degrees. The lumbar CT and MRI images showed three-segment stenosis in 24 cases, four-segment stenosis in 17 cases, and five-segment stenosis in 5 cases. A total of 165 stenosed segments included 12 L1,2, 34 L2,3, 43 L3,4, 45 L4,5, and 31 L5 and S1. Visual analogue scale (VAS) score, Oswestry disability index (ODI), and Japanese Orthopedic Association (JOA) score (29 points) were employed to evaluate effectiveness. Thirteen patients had leakage of cerebrospinal fluid during operation, and no infection was found after corresponding treatment; pulmonary infection and urinary system infection occurred in 4 and 2 patients respectively, who relieved after received antibiotic therapy; 8 patients with poor wound healing received dressing change, adequate drainage, debridement and suture. No death, paralysis, central nervous system infection, or other complication was observed in these patients. Forty-six cases were followed up 12-72 months (mean, 36.2 months). Lumbago and backache and intermittent claudication of lower extremity were obviously improved. During follow-up, no screw incising, loosening and broken screws, or pseudarthrosis was noted under X-ray film and CT scanning. At last follow-up, the lumbar Cobb angle was

  14. Pathoanatomical characteristics of clinical lumbar spinal stenosis.

    PubMed

    Tomkins-Lane, Christy C; Battié, Michele C; Hu, Richard; Macedo, Luciana

    2014-01-01

    There is no clear picture of pathoanatomy in clinically diagnosed LSS. Findings in the literature regarding imaging in LSS are heterogeneous. Characterize the pathoanatomy of LSS, as reported in the radiology reports, for a large community-based sample of patients with the clinical diagnosis of LSS. Retrospective review of clinical radiology reports. The sample comprised patients 40 years of age or older, with clinically diagnosed LSS. Radiology reports for lumbar MRI were obtained and data were extracted pertaining to the type and location of LSS. 173 subjects with a mean age of 66.2 ± 11.7 years were included (61% women). 68.2% had mixed stenosis, 19.1% had central stenosis only, and 12.7% had lateral stenosis only. By level, the most prevalent findings were at L4/5 (93%), L3/4 (66%) and L5/S1 (49%). This pattern was different in those with lateral stenosis only, where the proportion of findings at L5/S1 was higher than at L3/4. 156 subjects (90.2%) had findings of at least moderate severity. Considering moderate-severe findings only, 31% had mixed stenosis and 40.0% had multi-level findings (90.5% at adjacent segments). When mild findings were included for subjects with at least one moderate-severe finding the rate of mixed stenosis increased to 59%, and multi-level stenosis to 68.6%. The most common multi-level combinations were L3/4 and L4/5 for two-level stenosis and L2/3 through L4/5 for three-level. Results of this study confirm a number of pathoanatomical patterns in people diagnosed with LSS, including a high proportion of stenosis at L4/5, followed by L3/4 and L5/S1. Results also suggest a high prevalence of multi-level stenosis at adjacent segments. The prevalence of mixed stenosis varied from 31% to 68.2%; inclusion of mild findings resulted in a higher rate of both mixed and multi-level stenosis, compared to analysis of moderate-severe findings only. These results may guide future studies on LSS pathophysiology, by focusing attention toward the most

  15. Spinal Arachnoiditis as a Complication of Cryptococcal Meningoencephalitis in Non-HIV Previously Healthy Adults.

    PubMed

    Panackal, Anil A; Komori, Mika; Kosa, Peter; Khan, Omar; Hammoud, Dima A; Rosen, Lindsey B; Browne, Sarah K; Lin, Yen-Chih; Romm, Elena; Ramaprasad, Charu; Fries, Bettina C; Bennett, John E; Bielekova, Bibiana; Williamson, Peter R

    2017-02-01

    Cryptococcus can cause meningoencephalitis (CM) among previously healthy non-HIV adults. Spinal arachnoiditis is under-recognized, since diagnosis is difficult with concomitant central nervous system (CNS) pathology. We describe 6 cases of spinal arachnoiditis among 26 consecutively recruited CM patients with normal CD4 counts who achieved microbiologic control. We performed detailed neurological exams, cerebrospinal fluid (CSF) immunophenotyping and biomarker analysis before and after adjunctive immunomodulatory intervention with high dose pulse corticosteroids, affording causal inference into pathophysiology. All 6 exhibited severe lower motor neuron involvement in addition to cognitive changes and gait disturbances from meningoencephalitis. Spinal involvement was associated with asymmetric weakness and urinary retention. Diagnostic specificity was improved by MRI imaging which demonstrated lumbar spinal nerve root enhancement and clumping or lesions. Despite negative fungal cultures, CSF inflammatory biomarkers, sCD27 and sCD21, as well as the neuronal damage biomarker, neurofilament light chain (NFL), were elevated compared to healthy donor (HD) controls. Elevations in these biomarkers were associated with clinical symptoms and showed improvement with adjunctive high dose pulse corticosteroids. These data suggest that a post-infectious spinal arachnoiditis is an important complication of CM in previously healthy individuals, requiring heightened clinician awareness. Despite microbiological control, this syndrome causes significant pathology likely due to increased inflammation and may be amenable to suppressive therapeutics. Published by Oxford University Press for the Clinical Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  16. Use of autologous growth factors in lumbar spinal fusion.

    PubMed

    Lowery, G L; Kulkarni, S; Pennisi, A E

    1999-08-01

    The results of spinal fusion, especially posteriorly above the lumbosacral junction, have been mixed. Autologous growth factor concentrate (AGF) prepared by ultraconcentration of platelets contains multiple growth factors having a chemotactic and mitogenic effect on mesenchymal stem cells and osteoblasts and may play a role in initiating bone healing. The purpose of this retrospective study is to review our results with AGF in lumbar spinal fusions. To date, AGF has been used in 39 patients having lumbar spinal fusion. The study group consisted of the first 19 consecutive cases to allow at least 6 months follow-up. The average follow-up was 13 months (range 6 to 18 months). Follow-up compliance was 91%. There were 7 men and 12 women. Average age was 52 years (range 30-72 years). Nine patients had prior back surgery. There were 8 smokers. AGF was used in posterior (n = 15) or anterior intradiscal (n = 4) fusions. AGF was used with autograft and coraline hydroxyapatite in all posterior fusions, and autograft, coral, and intradiscal spacer (carbon fiber spinal fusion cages or Synthes femoral ring) in intradiscal fusions. Posterior stabilization was used in all cases. Eight cases were single-level fusions, 6 were two-level, and 1 was a three-level fusion. Autologous iliac crest bone graft was taken in 14 cases and local autograft used in 5 cases. Posteriorly, a total of 23 levels were fused; of these, nine were at L5-S1, eight at L4-L5, five at L3-L4, and one at L2-L3. No impending pseudoarthroses were noted on plain radiographic examination at last follow-up visit. Solid fusion was confirmed in 3 patients having routine hardware removal, and in 2 patients who had surgery at an adjacent level. There was one posterior wound infection, which was managed without sequelae. When used as an adjunct to autograft, AGF offers theoretical advantages that need to be examined in controlled studies. Further study is necessary to determine whether coralline hydroxyapatite used as a

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

    PubMed

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

    2016-04-01

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

  18. How I do it? Biportal endoscopic spinal surgery (BESS) for treatment of lumbar spinal stenosis.

    PubMed

    Choi, Chang Myong; Chung, Je Tea; Lee, Sang Jin; Choi, Dae Jung

    2016-03-01

    Prevalent endoscopic spine surgeries have shown limitations especially in spinal stenosis (Ahn in Neurosurgery 75(2):124-133, 2014). Biportal endoscopic surgery is introduced to manage central and foraminal stenosis with its wide range of access angle and clear view. The authors provide an introduction of this technique followed by a description of the surgical anatomy with discussion on its indications and advantages. In particular, tricks to avoid complications are also presented. Effective circumferential and focal decompression were achieved in most cases without damage to the spinal structural integrity with preservation of muscular and ligamentous attachments. The biportal endoscopic spinal surgery (BESS) may be safely used as an alternative minimally invasive procedure for lumbar spinal stenosis (Figs. 1 and 2).

  19. The effect of decompressive surgery on lumbar paraspinal and biceps brachii muscle function and movement perception in lumbar spinal stenosis: a 2-year follow-up.

    PubMed

    Kääriäinen, Tommi; Taimela, Simo; Aalto, Timo; Kröger, Heikki; Herno, Arto; Turunen, Veli; Savolainen, Sakari; Kankaanpää, Markku; Airaksinen, Olavi; Leinonen, Ville

    2016-03-01

    Chronic low back pain and lumbar spinal stenosis (LSS) seem to deteriorate lumbar muscle function and proprioception but the effect of surgery on them remains unclear. This study evaluates the effect of decompressive surgery on lumbar movement perception and paraspinal and biceps brachii (BB) muscle responses during sudden upper limb loading in LSS. Low back and radicular pain intensity (VAS) and Oswestry Disability Index (ODI) were measured together with lumbar proprioception and paraspinal and BB muscle responses prior to and 3 and 24 months after surgery in 30 LSS patients. Lumbar proprioception was assessed by a previously validated motorized trunk rotation unit and muscle responses for sudden upper limb loading by surface EMG. Lumbar perception threshold improved after surgery during 3-month follow-up (from 4.6° to 3.1°, P = 0.015) but tend to deteriorate again during 24 months (4.0°, P = 0.227). Preparatory paraspinal and BB muscle responses prior to sudden load as well as paraspinal muscle activation latencies after the load remained unchanged. Impaired lumbar proprioception seems to improve shortly after decompressive surgery but tends to deteriorate again with longer follow-up despite the sustaining favorable clinical outcome. The surgery did not affect either the feed-forward or the feed-back muscle function, which indicates that the abnormal muscle activity in LSS is at least partly irreversible.

  20. Predictors of Reoperation after Microdecompression in Lumbar Spinal Stenosis

    PubMed Central

    Hwang, Hee-Jong; Lee, Gwang-Soo; Heo, June-Young; Chang, Jae-Chil

    2016-01-01

    Objective The risk factors of reoperation after microdecompression (MD) for lumbar spinal stenosis (LSS) are unclear. In this study, we presented the outcomes of MD for degenerative LSS and investigated the risk factors associated with reoperation. Methods A retrospective review was conducted using the clinical records and radiographs of patients with LSS who underwent MD. For clinical evaluation, we used the Japanese Orthopedic Association (JOA) scoring system for low back pain, body mass index, and Charlson comorbidity index. For radiological evaluation, disc height, facet angle, and sagittal rotation angle were measured in operated segments. Also the Modic change and Pfirrmann grade for degeneration in the endplate and disc were scored. Results Forty-three patients aged 69±9 years at index surgery were followed for 48±25 months. The average preoperative JOA score was 6.9±1.6 points. The score improved to 9.1±2.1 points at the latest follow-up (p<0.001). Seven patients (16.3%) underwent reoperation. Clinical and radiological factors except operation level and Pfirrmann grade showed a p-value >0.1. Patients with Pfirrmann grade IV and lower lumbar segment had a 29.1% rate of reoperation (p=0.001), whereas patients without these factors had a 0% rate of reoperation. Conclusion Moderate disk degeneration (Pfirrmann IV) in lower lumbar segments is a risk factor of disk herniation or foraminal stenosis requiring reoperation after MD in LSS. PMID:28127375

  1. The relation between the lumbar vertebrae and the spinal nerves for far lateral lumbar spinal approaches.

    PubMed

    Güvençer, Mustafa; Naderi, Sait; Kiray, Amaç; Yilmaz, Hakan Sinan; Tetik, Süleyman

    2008-02-01

    The far lateral approaches to the lumbar spine require accurate knowledge of regional anatomy. The aim of this study is to evaluate the course of the lumbar nerve roots and their relation to important bony landmarks. Seven adult male cadavers fixed with formaldehyde were used. Morphometric parameters, including the lumbar nerve root diameters, the angle between the nerve roots and the midline, the transverse process length, the inter-transverse process height and width, and the relation between the nerve roots and the transverse processes of the caudal vertebrae were measured. It was observed that the diameter of the nerve roots, and the angle between the nerve roots and the midline, and the distance between the nerve roots and the lateral edge of the superior articular process increased gradually from L1 to L5. The diameter of the nerve root was 4.9+/-0.5mm for L1 and 7.5+/-1.0mm for L5. The midline nerve root angle was 36.1+/-1.6 degrees mm for L1 and 40.4+/-1.4 degrees mm for L5. The distance between the nerve root and the lateral edge of the superior articular process was 6.5+/-1.0mm for L1 and 11.4+/-1.6mm for L5. The nerve roots crossed the transverse processes of the caudal lumbar vertebrae. The nerve roots of L1 and L2 crossed the transverse processes in their first two quarters, the L3 nerve root crossed the transverse process in its second, third or fourth quarters, and the L4 nerve roots crossed the L5 transverse process in its third and fourth quarter or even external to it. Descending toward the lower lumbar vertebrae, the diameter of the lumbar nerve root increases and the nerve roots exit the intervertebral foramen with a larger angle. The special relation between the nerve roots and the caudal vertebra transverse process should be remembered during far lateral lumbar spine approaches.

  2. Effect of locomotor training in completely spinalized cats previously submitted to a spinal hemisection.

    PubMed

    Martinez, Marina; Delivet-Mongrain, Hugo; Leblond, Hugues; Rossignol, Serge

    2012-08-08

    After a spinal hemisection in cats, locomotor plasticity occurring at the spinal level can be revealed by performing, several weeks later, a complete spinalization below the first hemisection. Using this paradigm, we recently demonstrated that the hemisection induces durable changes in the symmetry of locomotor kinematics that persist after spinalization. Can this asymmetry be changed again in the spinal state by interventions such as treadmill locomotor training started within a few days after the spinalization? We performed, in 9 adult cats, a spinal hemisection at thoracic level 10 and then a complete spinalization at T13, 3 weeks later. Cats were not treadmill trained during the hemispinal period. After spinalization, 5 of 9 cats were not trained and served as control while 4 of 9 cats were trained on the treadmill for 20 min, 5 d a week for 3 weeks. Using detailed kinematic analyses, we showed that, without training, the asymmetrical state of locomotion induced by the hemisection was retained durably after the subsequent spinalization. By contrast, training cats after spinalization induced a reversal of the left/right asymmetries, suggesting that new plastic changes occurred within the spinal cord through locomotor training. Moreover, training was shown to improve the kinematic parameters and the performance of the hindlimb on the previously hemisected side. These results indicate that spinal locomotor circuits, previously modified by past experience such as required for adaptation to the hemisection, can remarkably respond to subsequent locomotor training and improve bilateral locomotor kinematics, clearly showing the benefits of locomotor training in the spinal state.

  3. Dislocation of a primary total hip arthroplasty is more common in patients with a lumbar spinal fusion.

    PubMed

    Buckland, A J; Puvanesarajah, V; Vigdorchik, J; Schwarzkopf, R; Jain, A; Klineberg, E O; Hart, R A; Callaghan, J J; Hassanzadeh, H

    2017-05-01

    Lumbar fusion is known to reduce the variation in pelvic tilt between standing and sitting. A flexible lumbo-pelvic unit increases the stability of total hip arthroplasty (THA) when seated by increasing anterior clearance and acetabular anteversion, thereby preventing impingement of the prosthesis. Lumbar fusion may eliminate this protective pelvic movement. The effect of lumbar fusion on the stability of total hip arthroplasty has not previously been investigated. The Medicare database was searched for patients who had undergone THA and spinal fusion between 2005 and 2012. PearlDiver software was used to query the database by the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedural code for primary THA and lumbar spinal fusion. Patients who had undergone both lumbar fusion and THA were then divided into three groups: 1 to 2 levels, 3 to 7 levels and 8+ levels of fusion. The rate of dislocation in each group was established using ICD-9-CM codes. Patients who underwent THA without spinal fusion were used as a control group. Statistical significant difference between groups was tested using the chi-squared test, and significance set at p < 0.05. At one-year follow-up, 14 747 patients were found to have had a THA after lumbar spinal fusion (12 079 1 to 2 levels, 2594 3 to 7 levels, 74 8+ levels). The control group consisted of 839 004 patients. The dislocation rate in the control group was 1.55%. A higher rate of dislocation was found in patients with a spinal fusion of 1 to 2 levels (2.96%, p < 0.0001) and 3 to 7 levels (4.12%, p < 0.0001). Patients with 3 to 7 levels of fusion had a higher rate of dislocation than patients with 1 to 2 levels of fusion (odds ratio (OR) = 1.60, p < 0.0001). When groups were matched for age and gender to the unfused cohort, patients with 1 to 2 levels of fusion had an OR of 1.93 (95% confidence interval (CI) 1.42 to 2.32, p < 0.001), and those with 3 to 7 levels of fusion an OR of 2.77 (CI

  4. Diabetes Mellitus, a New Risk Factor for Lumbar Spinal Stenosis: A Case-Control Study.

    PubMed

    Asadian, Leila; Haddadi, Kaveh; Aarabi, Mohsen; Zare, Amirhossein

    2016-01-01

    This study aimed to determine the prevalence of diabetes mellitus in patients with spinal stenosis and lumbar vertebral disk degeneration, and the correlation of diabetes with these diseases. This is a cross-sectional study. This case-control study was performed during 2012-2014 with 110 patients suffering from lumbar spinal stenosis and 110 patients with lumbar disk herniation, who were diagnosed using clinical and radiological evidences. Additionally, 110 participants who were referred to the clinic and did not show clinical signs of degenerative diseases of the lumbar spine entered the study as a control group. Demographic data and medical histories of the patients were collected using checklists. A total of 50 patients (15.2%) were diagnosed with diabetes, which comprised 32 (29.1%) in the stenosis group, 7 (6.4%) in the lumbar disk herniation group, and 11 (10%) in the control group. The prevalence of diabetes in women with spinal stenosis and women with lumbar disk herniation was 35.9% and 10.3%, respectively, whereas prevalence of diabetes in women was 10.9% in the control group. This difference was statistically significant in the spinal stenosis group in comparison with the controls (P < 0.0001). Conversely, no significant difference was found in men. There is an association between diabetes and lumbar spinal stenosis. Diabetes mellitus may be a predisposing factor for the development of lumbar spinal stenosis.

  5. Diabetes Mellitus, a New Risk Factor for Lumbar Spinal Stenosis: A Case–Control Study

    PubMed Central

    Asadian, Leila; Haddadi, Kaveh; Aarabi, Mohsen; Zare, Amirhossein

    2016-01-01

    OBJECTIVES This study aimed to determine the prevalence of diabetes mellitus in patients with spinal stenosis and lumbar vertebral disk degeneration, and the correlation of diabetes with these diseases. STUDY DESIGN This is a cross-sectional study. METHODS This case–control study was performed during 2012–2014 with 110 patients suffering from lumbar spinal stenosis and 110 patients with lumbar disk herniation, who were diagnosed using clinical and radiological evidences. Additionally, 110 participants who were referred to the clinic and did not show clinical signs of degenerative diseases of the lumbar spine entered the study as a control group. Demographic data and medical histories of the patients were collected using checklists. RESULTS A total of 50 patients (15.2%) were diagnosed with diabetes, which comprised 32 (29.1%) in the stenosis group, 7 (6.4%) in the lumbar disk herniation group, and 11 (10%) in the control group. The prevalence of diabetes in women with spinal stenosis and women with lumbar disk herniation was 35.9% and 10.3%, respectively, whereas prevalence of diabetes in women was 10.9% in the control group. This difference was statistically significant in the spinal stenosis group in comparison with the controls (P < 0.0001). Conversely, no significant difference was found in men. CONCLUSIONS There is an association between diabetes and lumbar spinal stenosis. Diabetes mellitus may be a predisposing factor for the development of lumbar spinal stenosis. PMID:27168730

  6. Early experience with endoscopic revision of lumbar spinal fusions.

    PubMed

    McGrath, Lynn B; Madhavan, Karthik; Chieng, Lee Onn; Wang, Michael Y; Hofstetter, Christoph P

    2016-02-01

    Approximately half a million spinal fusion procedures are performed annually in the US. It is estimated that up to one-third of arthrodesis constructs require revision surgeries. In this study the authors present endoscopic treatment strategies targeting 3 types of complications following arthrodesis surgery: 1) adjacent-level foraminal stenosis; 2) foraminal stenosis at an arthrodesis segment; and 3) stenosis caused by a displaced interbody cage. A retrospective chart review of 11 patients with a mean age of 68 ± 15 years was performed (continuous variables are shown as the mean ± SEM). All patients had a history of lumbar arthrodesis surgery and suffered from unilateral radiculopathy. Endoscopic revision surgeries were done as outpatient procedures, and there were no intraoperative or perioperative complications. The cohort included 3 patients with foraminal stenosis at the level of previous arthrodesis. They presented with unilateral radicular leg pain (visual analog scale [VAS] score: 7.3 ± 2.1) and were severely disabled, as evidenced by an Oswestry Disability Index (ODI) of 46 ± 4.9. Transforaminal endoscopic foraminotomies were performed, and at a mean follow-up time of 9.0 ± 2.5 months VAS was reduced by an average of 6.3. The cohort also includes 7 patients suffering unilateral radiculopathy due to adjacent-level foraminal stenosis. Preoperative VAS for leg pain of the symptomatic side was 6.0 ± 1.6, VAS for back pain was 5.2 ± 1.7, and ODI was 40 ± 6.33. Endoscopic decompression led to reduction of the ipsilateral leg VAS score by an average of 5, resulting in leg pain of 1 ± 0.5 at an average of 8 months of follow-up. The severity of back pain remained stable (VAS 4.2 ± 1.4). Two of these patients required revision surgery for recurrent symptoms. Finally, this study includes 1 patient who presented with weakness and pain due to retropulsion of an L5/S1 interbody spacer. The patient underwent an endoscopic interlaminar approach with partial

  7. Sparing of Descending Axons Rescues Interneuron Plasticity in the Lumbar Cord to Allow Adaptive Learning After Thoracic Spinal Cord Injury.

    PubMed

    Hansen, Christopher N; Faw, Timothy D; White, Susan; Buford, John A; Grau, James W; Basso, D Michele

    2016-01-01

    This study evaluated the role of spared axons on structural and behavioral neuroplasticity in the lumbar enlargement after a thoracic spinal cord injury (SCI). Previous work has demonstrated that recovery in the presence of spared axons after an incomplete lesion increases behavioral output after a subsequent complete spinal cord transection (TX). This suggests that spared axons direct adaptive changes in below-level neuronal networks of the lumbar cord. In response to spared fibers, we postulate that lumbar neuron networks support behavioral gains by preventing aberrant plasticity. As such, the present study measured histological and functional changes in the isolated lumbar cord after complete TX or incomplete contusion (SCI). To measure functional plasticity in the lumbar cord, we used an established instrumental learning paradigm (ILP). In this paradigm, neural circuits within isolated lumbar segments demonstrate learning by an increase in flexion duration that reduces exposure to a noxious leg shock. We employed this model using a proof-of-principle design to evaluate the role of sparing on lumbar learning and plasticity early (7 days) or late (42 days) after midthoracic SCI in a rodent model. Early after SCI or TX at 7 days, spinal learning was unattainable regardless of whether the animal recovered with or without axonal substrate. Failed learning occurred alongside measures of cell soma atrophy and aberrant dendritic spine expression within interneuron populations responsible for sensorimotor integration and learning. Alternatively, exposure of the lumbar cord to a small amount of spared axons for 6 weeks produced near-normal learning late after SCI. This coincided with greater cell soma volume and fewer aberrant dendritic spines on interneurons. Thus, an opportunity to influence activity-based learning in locomotor networks depends on spared axons limiting maladaptive plasticity. Together, this work identifies a time dependent interaction between spared

  8. Foot drop resulting from degenerative lumbar spinal diseases: clinical characteristics and prognosis.

    PubMed

    Wang, Yue; Nataraj, Andrew

    2014-02-01

    Foot drop is a condition that can substantially add to the disability of patients with degenerative lumbar spinal disorders. The most common degenerative conditions associated with foot drop are lumbar disc herniation and lumbar spinal stenosis. The level most commonly affected is the L4/5 spinal level. Most patients are treated with surgery, although there is insufficient evidence to support that surgery is superior to conservative therapy. In most surgical patients, foot dorsiflexion will improve to some degree. The preoperative power of foot dorsiflexion is the key factor associated with prognosis. Copyright © 2013 Elsevier B.V. All rights reserved.

  9. Neurogenic claudication without spinal stenosis arising as a result of lumbar epidural varices.

    PubMed

    Dabasia, H; Rahim, N; Marshall, R

    2012-09-01

    Neurogenic claudication is most frequently observed in patients with degenerative lumbar spinal stenosis. We describe a patient with lumbar epidural varices secondary to obstruction of the inferior vena cava by pathological lymph nodes presenting with this syndrome. Following a diagnosis of follicular lymphoma, successful chemotherapy led to the resolution of the varices and the symptoms of neurogenic claudication. The lumbar epidural venous plexus may have an important role in the pathogenesis of spinal stenosis. Although rare, epidural venous engorgement can induce neurogenic claudication without spinal stenosis. Further investigations should be directed at identifying an underlying cause.

  10. Relief of Lumbar Symptoms After Cervical Decompression in Patients with Tandem Spinal Stenosis Presenting with Primarily Lumbar Pain

    PubMed Central

    Felbaum, Daniel R; Stewart, Jeffrey J; Sandhu, Faheem A

    2016-01-01

    Objective: Tandem cervical and lumbar spinal stenosis (TSS) is classically described as intermittent claudication, gait disturbance, and clinical findings of mixed myelopathy and polyradiculopathy. Rarely, patients can present with TSS manifesting in isolated lumbar pain. Several reports have demonstrated improved lumbar back pain and radiculopathy after decompressive cervical spine procedures. We present six patients with dramatic resolution of lumbar spine related symptoms after decompression of the cervical spinal cord despite presenting solely with lower back complaints. Methods: Clinical records of the senior author (F.A.S.) gathered from April 2006 to March 2013 were retrospectively reviewed identifying six patients presenting solely with lumbar symptoms and diagnosed with TSS based on history and physical examination. Results: Six patients with a mean age of 55 (range 39 to 60) presented with solely lower back symptoms and clinical findings suspicious for TSS. Mean follow-up time for all patients was 12 months (range three to 27 months, median 11.5 months). Three patients underwent a cervical procedure as the principal operation, while the remainder had the lumbar spine decompressed initially. All patients that underwent a cervical procedure initially experienced a dramatic decrease or complete resolution of their preoperative lower back pain and radiculopathy (mean preoperative VAS of 6.7 vs. 3.7 postoperative). The remainder of patients with persistent lumbar symptoms resolved after a subsequent cervical operation. Conclusion: Patients presenting with lumbar symptoms out of proportion to imaging require further investigation. We highlight the resolution of lumbar symptoms after a cervical procedure in a select group of patients presenting with lone lower back complaints. In patients presenting with symptoms disproportionate to lumbar imaging, treatment of cervical pathology may provide robust long-term relief of the initial lumbar-related presentation

  11. The Effect of Lumbar Spinal Muscle on Spinal Sagittal Alignment: Evaluating Muscle Quantity and Quality.

    PubMed

    Jun, Hyo Sub; Kim, Ji Hee; Ahn, Jun Hyong; Chang, In Bok; Song, Joon Ho; Kim, Tae Hwan; Park, Moon Soo; Chan Kim, Yong; Kim, Seok Woo; Oh, Jae Keun; Yoon, Do Heum

    2016-12-01

    The majority of earlier studies of the parameters of sagittal balance did not consider the influence of spinal muscles on spinal sagittal alignment. To analyze the relationship between the paraspinal muscle (quantity and quality) and sagittal alignment in elderly patients. We reviewed 50 full-spine lateral standing radiographs and lumbar magnetic resonance images of elderly patients at a single center. The radiographic parameters examined were thoracic kyphosis, lumbar lordosis (LL), sagittal vertical axis, pelvic tilt, sacral slope, and pelvic incidence (PI). The lumbar muscularity (LM; quantity) and fatty degeneration ratio (FD; quality) in the paraspinal muscle were measured at the L3 level on magnetic resonance images. The relationships between the parameters, LM, and FD were analyzed with the Pearson correlation coefficient and multiple linear regression. Pearson analysis demonstrated that the FD had significant correlations with age (r = 0.393), thoracic kyphosis (r = -0.559), pelvic tilt (r = 0.430), sagittal vertical axis (r = 0.488), and PI - LL (r = 0.479, P < .05), and a close negative correlation was found between the FD and LL (r = -0.505, P < .01). The LM had significant correlations with the LL (r = 0.342) and PI - LL (r = -0.283, P < .05). Regression models that controlled for confounding factors such as body mass index confirmed the correlations between the above parameters and FD (P < .05). The quality of the paraspinal muscle could be one of the various factors that influence sagittal balance. BMI, body mass indexCSA, cross-sectional areaFD, fatty degeneration ratioLL, lumbar lordosisLM, lumbar muscularityPI, pelvic incidencePT, pelvic tiltSC, subcutaneous fatSS, sacral slopeSVA, sagittal vertical axisTK, thoracic kyphosisVB, vertebral body.

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

    PubMed

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

    2016-11-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2016-11-01

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

  14. A rabbit model of lumbar distraction spinal cord injury.

    PubMed

    Wu, Ji; Xue, Jing; Huang, Rongrong; Zheng, Chao; Cui, Yuming; Rao, Shucheng

    2016-05-01

    Excessive spinal distraction is a major cause of distraction spinal cord injury (SCI) during spinal deformity correction surgery. However, the lack of animal models of gradable and replicable distraction SCI has hampered research about how it occurs and how it can be prevented. The rabbit is a suitable choice for a model because it is more similar to humans than the rat, the most often used for studies of distraction SCI. The rabbit is readily acquired and reasonably affordable to maintain. The study aims to develop a gradable and replicable animal model of human lumbar distraction SCI. This is an animal laboratory study. We built a spine distractor designed to vary the percentage of spine distraction by changing the movement between the bony landmarks of the spine. Anesthetized rabbits underwent surgery to expose the vertebral segments from T12 through L4. The distractor was mounted onto the T12 and L4 vertebral segments, and distraction was effected by turning the distractor's central screw to 0% (control), 10%, 20%, or 30% of the length from the L1 to the L4 vertebral segments, with eight rabbits in each group. Cortical somatosensory evoked potentials were recorded, and neurologic function was evaluated before the distractor was mounted and after the distractor was dismounted. The rabbits were killed, and spinal cord samples were taken for biochemical, histopathologic, and stereologic studies. With increasing percentage distraction, the extent of distraction SCI increased as measured by recordings of cortical somatosensory evoked potentials, neurologic function, and biochemical, histopathologic, and stereologic studies. Our model can be widely applied to studies of the causes of and treatment for distraction SCI. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. The rodent lumbar spinal cord learns to correct errors in hindlimb coordination caused by viscous force perturbations during stepping.

    PubMed

    Heng, Chad; de Leon, Ray D

    2007-08-08

    The nervous system can adapt to external forces that perturb locomotion by correcting errors in limb movements. It is believed that supraspinal structures mediate these adaptations, whereas the spinal cord contributes only reflexive responses to perturbations. We examined whether the lumbar spinal cord in postnatal day 5 neonatal spinally transected (ST) rats corrected errors in hindlimb coordination through repetitive exposure to an external perturbation. A robotic device was used to deliver a viscous (velocity-dependent) force that opposed only the forward movement of the ankle in one hindlimb while the ST rats performed hindlimb stepping on a treadmill. We measured the interval between paw contact in the perturbed hindlimb and toe off in the unperturbed hindlimb. Before the force was activated, a normal pattern of coordination occurred: paw contact in the perturbed hindlimb occurred before toe off in the unperturbed hindlimb. This sequence was initially disrupted when the force was activated and the unperturbed hindlimb initiated swing during the swing phase of the perturbed hindlimb. Within five step cycles of exposure to the unilateral viscous force, however, the ST rats regained the preforce pattern of hindlimb coordination. These findings suggest that in the absence of supraspinal input, the lumbar spinal circuitry is capable of processing a complex ensemble of sensory information to maintain locomotor stability. Thus, the lumbar spinal circuitry may play a greater role in generating locomotor adaptations than previously thought.

  16. Thoracic epidural spinal angiolipoma with coexisting lumbar spinal stenosis: Case report and review of the literature

    PubMed Central

    Benvenutti-Regato, Mario; De la Garza-Ramos, Rafael

    2015-01-01

    Background Spinal angiolipomas (SALs) are uncommon benign lesions that may present insidiously with back pain or acutely with weakness due to tumor bleeding/thrombosis. Given their rarity, these lesions are often overlooked in the differential diagnosis of epidural masses. The purpose of this article is to report the case of an epidural SAL and to conduct a literature review on the topic. Methods A case report and review of the literature using the PubMed/Medline databases. All case reports and case series were reviewed up to June 2015. Results A 65-year old female presented with neurogenic claudication and magnetic resonance imaging (MRI) revealed lumbar spinal stenosis. Following decompressive surgery, she experienced symptom resolution, but three months postoperatively she presented to the emergency department with acute paraparesis. A thoracic MRI revealed a lesion located between T8 and T10 causing severe spinal cord compression. Following emergent laminectomy and en bloc resection, the patient regained function and the lesion was diagnosed as SAL. Our literature review revealed 178 reported cases, with a female and thoracic predominance. The majority of patients underwent surgical treatment, achieving a gross total resection in most cases. Similarly, complete symptom resolution was the most common outcome. Conclusion Spinal angiolipomas are uncommon spinal tumors. However, they may be treated as any other space-occupying lesion, and surgical resection allows for complete symptom recovery in most patients. PMID:26767159

  17. The role of spinal instrumentation in augmenting lumbar posterolateral fusion.

    PubMed

    Kotani, Y; Cunningham, B W; Cappuccino, A; Kaneda, K; McAfee, P C

    1996-02-01

    Using a sheep model, clinically practical posterolateral intertransverse process fusion was successfully achieved and biomechanically tested to determine the load-sharing environment provided by spinal instrumentation and posterolateral fusion mass following solid arthrodesis. To quantify the in vivo load-sharing capacity of spinal instrumentation on augmenting the posterolateral intertransverse fusion. The hypothesis was that transpedicular screw fixation maintains the biomechanical contribution to the posterolateral fusion stability even after successful arthrodesis because of its providing anterior and middle column support. Although many previous studies have documented the biological and biomechanical advantages of posterolateral fusion, it is known that posterolateral fusion without spinal instrumentation allowed significant remaining motion at the fused segment even after the solid arthrodesis. Whether spinal instrumentation, especially transpedicular screw fixation, augments in vivo posterolateral fusion stability after solid arthrodesis has not been previously investigated. Radiographic, macroscopic, and biomechanical analyses of a posterolateral intertransverse process fusion model were performed on 18 sheep at 4 months postoperatively. The load-sharing contribution of the spinal instrumentation was calculated based on the stability with or without spinal instrumentation tested in five loading modalities. Histomorphometry of the vertebral body spanned by spinal instrumentation provided the information regarding the biological effect of the load-sharing capacity of spinal instrumentation on bone remodeling. All sheep who received posterolateral intertransverse process fusion demonstrated successful solid arthrodesis and high biomechanical quality of the posterolateral fusion mass when compared to previous posterolateral fusion models. The significant difference in stiffness between fixation and subsequent fixation removal was observed in flexion, despite

  18. Inter- and Intraobserver Agreement of Morphological Grading for Central Lumbar Spinal Stenosis on Magnetic Resonance Imaging

    PubMed Central

    Weber, Clemens; Rao, Vidar; Gulati, Sasha; Kvistad, Kjell A.; Nygaard, Øystein P.; Lønne, Greger

    2015-01-01

    Study Design Validation study of a morphological grading system for central lumbar spinal stenosis. Objective To evaluate and validate the inter- and intraobserver agreement of a morphological grading system for central lumbar spinal stenosis on magnetic resonance imaging between neurosurgeons and radiologists. Methods Two neurosurgeons and two radiologists independently assessed the morphological grading of lumbar spinal stenosis on pretreatment magnetic resonance imaging of 84 patients. Inter- and intrarater agreements were calculated by comparing the observers' evaluations level to level on the grading method. The results of both clinicians were compared with the assessment of both radiologists. Results On axial magnetic resonance images, 189 lumbar disk levels were evaluated for the grade of stenosis. The interobserver agreement between the clinicians was substantial. The interobserver agreement between clinician 1 and both radiologists was substantial, and it was moderate between clinician 2 and both radiologists. The clinicians' intraobserver agreement was almost perfect, and the radiologists' intraobserver agreement was substantial. Conclusions The interobserver agreement of this morphological grading for lumbar spinal stenosis was high between both the clinicians and radiologists, whereas the intraobserver agreement was almost perfect. Experienced clinicians may safely evaluate lumbar magnetic resonance images using this morphological grading for central lumbar spinal stenosis. PMID:26430595

  19. Inter- and Intraobserver Agreement of Morphological Grading for Central Lumbar Spinal Stenosis on Magnetic Resonance Imaging.

    PubMed

    Weber, Clemens; Rao, Vidar; Gulati, Sasha; Kvistad, Kjell A; Nygaard, Øystein P; Lønne, Greger

    2015-10-01

    Study Design Validation study of a morphological grading system for central lumbar spinal stenosis. Objective To evaluate and validate the inter- and intraobserver agreement of a morphological grading system for central lumbar spinal stenosis on magnetic resonance imaging between neurosurgeons and radiologists. Methods Two neurosurgeons and two radiologists independently assessed the morphological grading of lumbar spinal stenosis on pretreatment magnetic resonance imaging of 84 patients. Inter- and intrarater agreements were calculated by comparing the observers' evaluations level to level on the grading method. The results of both clinicians were compared with the assessment of both radiologists. Results On axial magnetic resonance images, 189 lumbar disk levels were evaluated for the grade of stenosis. The interobserver agreement between the clinicians was substantial. The interobserver agreement between clinician 1 and both radiologists was substantial, and it was moderate between clinician 2 and both radiologists. The clinicians' intraobserver agreement was almost perfect, and the radiologists' intraobserver agreement was substantial. Conclusions The interobserver agreement of this morphological grading for lumbar spinal stenosis was high between both the clinicians and radiologists, whereas the intraobserver agreement was almost perfect. Experienced clinicians may safely evaluate lumbar magnetic resonance images using this morphological grading for central lumbar spinal stenosis.

  20. Modified fenestration with restorative spinoplasty for lumbar spinal stenosis.

    PubMed

    Matsudaira, Ko; Yamazaki, Takashi; Seichi, Atsushi; Hoshi, Kazuto; Hara, Nobuhiro; Ogiwara, Satoshi; Terayama, Sei; Chikuda, Hirotaka; Takeshita, Katsushi; Nakamura, Kozo

    2009-06-01

    The authors developed an original procedure, modified fenestration with restorative spinoplasty (MFRS) for the treatment of lumbar spinal stenosis. The first step is to cut the spinous process in an L-shape, which is caudally reflected. This procedure allows easy access to the spinal canal, including lateral recesses, and makes it easy to perform a trumpet-style decompression of the nerve roots without violating the facet joints. After the decompression of neural tissues, the spinous process is anatomically restored (spinoplasty). The clinical outcomes at 2 years were evaluated using the Japanese Orthopaedic Association (JOA) scale and patients' satisfaction. Radiological follow-up included radiographs and CT. Between January 2000 and December 2002, 109 patients with neurogenic intermittent claudication with or without mild spondylolisthesis underwent MFRS. Of these, 101 were followed up for at least 2 years (follow-up rate 93%). The average score on the self-administered JOA scale in 89 patients without comorbidity causing gait disturbance improved from 13.3 preoperatively to 22.9 at 2 years' follow-up. Neurogenic intermittent claudication disappeared in all cases. The patients' assessment of treatment satisfaction was "satisfied" in 74 cases, "slightly satisfied" in 12, "slightly dissatisfied" in 2, and "dissatisfied" in 1 case. In 16 cases (18%), a minimum progression of slippage occurred, but no symptomatic instability or recurrent stenosis was observed. Computed tomography showed that the lateral part of the facet joints was well preserved, and the mean residual ratio was 80%. The MFRS technique produces an adequate and safe decompression of the spinal canal, even in patients with narrow and steep facet joints in whom conventional fenestration is technically demanding.

  1. Management of Deep Infection after Instrumentation on Lumbar Spinal Surgery in a Single Institution

    PubMed Central

    Liu, Jung-Tung; Liao, Wen-Jui; Chang, Cheng-Siu; Chen, Yung-Hsiang

    2015-01-01

    Postoperative surgical site infections (SSIs) are more common complications after spinal surgery. SSIs often require extended hospitalisation and may worsen overall clinical outcomes. A retrospective database review of consecutive patients with traditional open lumbar spinal surgery was performed. SSIs patients were identified and reviewed for clinically relevant details, and postoperative SSIs' incidence was calculated for the entire cohort as well as for subgroups with or without spinal implants. In 15 years, 1,176 patients underwent open lumbar spinal surgery with spinal implants and 699 without. Thirty-eight developed postoperative SSIs. Total SSI rate for the entire group was 2.03%. The incidence of postoperative SSIs in the nonimplant group was relatively low. Patients received antibiotics, hyperbaric oxygen therapy, and wet dressing. We provided the precise rates of postoperative SSIs in traditional open spinal surgery obtained from a single-centre data. Patients with spinal implants had higher SSIs' incidence than those without. PMID:26273650

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

    PubMed Central

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

    2015-01-01

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

  3. Does the effectiveness of core stability exercises correlate with the severity of spinal stenosis in patients with lumbar spinal stenosis?

    PubMed

    Chen, Chaxiang; Lin, Zhichao; Zhang, Yingjie; Chen, Zemin; Tang, Shujie

    2017-01-01

    To determine whether the effectiveness of core stability exercises correlates with the severity of spinal stenosis in patients with degenerative lumbar spinal stenosis. Forty-two patients with degenerative lumbar spinal stenosis treated in the department of orthopedics of our hospital between May 2013 and January 2016 were included in the study. All the patients performed core stability exercises once daily for six weeks, and the clinical outcomes were evaluated using Japanese Orthopaedic Association (JOA) score and self-reported walking capacity. The anteroposterior osseous spinal canal diameter was measured to evaluate the severity of spinal stenosis. The correlation between the stenosis degree and the differences of Japanese Orthopaedic Association score or self-reported walking capacity at baseline and after treatment were analyzed. The patients were divided into three groups according to the spinal stenosis degree. In the three groups, there was no significant difference in JOA or self-reported walking distance at baseline (p>0.05) and after treatment (p>0.05). The JOA scores and self-reported walking distance were significantly increased after treatment (p<0.05) in any of the three groups when compared to the baseline. Also, there was no significant correlation between the stenosis degree and the difference of JOA (p>0.05) or self-reported walking distance (p>0.05). There was no significantcorrelation between the effectiveness of core stability exercises and the severity of spinal stenosis in patients with degenerative lumbar spinal stenosis.

  4. Hospital competitive intensity and perioperative outcomes following lumbar spinal fusion.

    PubMed

    Durand, Wesley M; Johnson, Joseph R; Li, Neill Y; Yang, JaeWon; Eltorai, Adam E M; DePasse, J Mason; Daniels, Alan H

    2017-09-04

    Inter-hospital competition has been shown to influence adoption of surgical techniques and approaches, clinical patient outcomes, and healthcare resource utilization for select surgical procedures. However, little is known regarding these dynamics as they relate to spine surgery. This investigation sought to examine the relationship between inter-hospital competitive intensity and perioperative outcomes following lumbar spinal fusion. This study utilized the Nationwide Inpatient Sample (NIS) dataset, years 2003, 2006, and 2009. Patients were included based on the presence of International Classification of Disease, 9(th) Edition, Clinical Modification (ICD-9-CM) codes corresponding to lumbar spinal fusion, as well as on the presence of data on the Herfindahl-Hirschman Index (HHI). Perioperative complications, defined using an ICD-9-CM coding algorithm. The HHI, a validated measure of competition within a market, was utilized to assess hospital market competitiveness. HHI was calculated based on hospital cachement area. Multiple regression was performed to adjust for confounding variables including: patient age, sex, primary payer, severity of illness score, primary vs. revision fusion, anterior vs. posterior approach, national region, hospital bed size, location/teaching status, ownership, and year. Perioperative clinical outcomes were assessed based on ICD-9-CM codes with modifications. In total, 417,520 weighted patients (87,999 unweighted records) were analyzed. The mean cachement area HHI was 0.31 (range 0.099 - 0.724). The average patient age was 55.4 years (SE = 0.194), and the majority of patients were female (55.8%, n=232,727). The majority of procedures were primary spinal fusions (92.7%, n=386,998), and fusions with posterior-only technique (81.5%, n=340,271). Most procedures occurred in the South (42.5%, n=177,509) or Midwest (27.0%, n=112,758) regions. In multiple regression analysis, increased hospital competitive intensity was associated with

  5. Association of Neuromuscular Attributes With Performance-Based Mobility Among Community-Dwelling Older Adults With Symptomatic Lumbar Spinal Stenosis.

    PubMed

    Schmidt, Catherine T; Ward, Rachel E; Suri, Pradeep; Kiely, Dan K; Ni, Pengsheng; Anderson, Dennis E; Bean, Jonathan F

    2017-07-01

    To identify differences in health factors, neuromuscular attributes, and performance-based mobility among community-dwelling older adults with symptomatic lumbar spinal stenosis; and to determine which neuromuscular attributes are associated with performance-based measures of mobility. Cross-sectional; secondary data analysis of a cohort study. Outpatient rehabilitation center. Community-dwelling adults aged ≥65 years with self-reported mobility limitations and symptomatic lumbar spinal stenosis (N=54). Not applicable. Short Physical Performance Battery score, habitual gait speed, and chair stand test. Symptomatic lumbar spinal stenosis was classified using self-reported symptoms of neurogenic claudication and imaging. Among 430 community-dwelling older adults, 54 (13%) met criteria for symptomatic lumbar spinal stenosis. Compared with participants without symptomatic lumbar spinal stenosis, those with symptomatic lumbar spinal stenosis had more comorbidities, higher body mass index, greater pain, and less balance confidence. Participants with symptomatic lumbar spinal stenosis had greater impairment in trunk extensor muscle endurance, leg strength, leg strength asymmetry, knee flexion range of motion (ROM), knee extension ROM, and ankle ROM compared with participants without symptomatic lumbar spinal stenosis. Five neuromuscular attributes were associated with performance-based mobility among participants with symptomatic lumbar spinal stenosis: trunk extensor muscle endurance, leg strength, leg strength asymmetry, knee flexion ROM, and knee extension ROM asymmetry. Community-dwelling older adults with self-reported mobility limitations and symptomatic lumbar spinal stenosis exhibit poorer health characteristics, greater neuromuscular impairment, and worse mobility when compared with those without symptomatic lumbar spinal stenosis. Poorer trunk extensor muscle endurance, leg strength, leg strength asymmetry, knee flexion ROM, and knee extension ROM asymmetry

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

    NASA Astrophysics Data System (ADS)

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

    2017-10-01

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

  7. Multicentric spinal cord and brain glioblastoma without previous craniotomy

    PubMed Central

    de Eulate-Beramendi, Sayoa A.; Piña-Batista, Kelvin M.; Rodrigo, Victor; Torres-Rivas, Hector E.; Rial-Basalo, Juan C.

    2016-01-01

    Background: Glioblastoma multiforme (GBS) is a highly malignant glioma that rarely presents as an infratentorial tumor. Multicentric gliomas lesions are widely separated in site and/or time and its incidence has been reported between 0.15 and 10%. Multicentric gliomas involving supratentorial and infratentorial region are even more rare. In most cases, infratentorial disease is seen after surgical manipulation or radiation therapy and is usually located in the cerebellum or cervical region. Case Report: We present a rare case of symptomatic multicentric glioma in the brain, fourth ventricle, cervical as well as lumbar glioblastoma in an adult without previous therapeutic intervention. We also review the literature of this rare presentation. Conclusions: This report suggests that GBM is a diffuse disease; the more extended the disease, the worse prognosis it has. The management still remains controversial and further studies are required to understand the prognosis factors of dissemination. PMID:27512613

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

    PubMed

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

    2017-09-17

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

  9. Neuropathic Pain Components in Patients with Lumbar Spinal Stenosis

    PubMed Central

    An, Howard S; Moon, Seong Hwan; Lee, Hwan Mo; Suh, Seung Woo; Chen, Ding; Jeon, Jin Ho

    2015-01-01

    Purpose To determine the prevalence and characteristics of neuropathic pain (NP) in patients with lumbar spinal stenosis (LSS) according to subgroup analysis of symptoms. Materials and Methods We prospectively enrolled subjects with LSS (n=86) who were scheduled to undergo spinal surgery. The patients were divided into two groups according to a chief complaint of radicular pain or neurogenic claudication. We measured patient's pain score using the visual analog scale (VAS), Oswestry Disability Index (ODI) and Leads Assessment of Neuropathic Symptoms and Signs (LANSS). According to LANSS value, the prevalence of NP component pain in patients with LSS was assessed. Statistical analysis was performed to find the relationship between LANSS scores and the other scores. Results From our sample of 86 patients, 31 (36.0%) had a NP component, with 24 (63.4%) in the radicular pain group having NP. However, only seven patients (15.6%) in the neurogenic claudication group had NP. The LANSS pain score was not significantly correlated with VAS scores for back pain, but did correlate with VAS scores for leg pain (R=0.73, p<0.001) and with ODI back pain scores (R=0.54, p<0.01). Conclusion One-third of the patients with LSS had a NP component. The presence of radicular pain correlated strongly with NP. The severity of leg pain and ODI score were also closely related to a NP component. This data may prove useful to understanding the pain characteristics of LSS and in better designing clinical trials for NP treatment in patients with LSS. PMID:26069129

  10. Cost Utility Analysis of Lumbar Interlaminar Epidural Injections in the Treatment of Lumbar Disc Herniation, Central Spinal Stenosis, and Axial or Discogenic Low Back Pain.

    PubMed

    Manchikanti, Laxmaiah; Pampati, Vidyasagar; Benyamin, Ramsin M; Hirsch, Joshua A

    2017-05-01

    Cost utility or cost effective analysis continues to take center stage in the United States for defining and measuring the value of treatments in interventional pain management. Appropriate cost utility analysis has been performed for caudal epidural injections, percutaneous adhesiolysis, and spinal cord stimulation. However, the literature pertaining to lumbar interlaminar epidural injections is lacking, specifically in reference to cost utility analysis derived from randomized controlled trials (RCTs) with a pragmatic approach in a practical setting. To assess the cost utility of lumbar interlaminar epidural injections in managing chronic low back and/or lower extremity pain secondary to lumbar disc herniation, spinal stenosis, and axial or discogenic low back pain. Analysis based on 3 previously published randomized trials of effectiveness of lumbar interlaminar epidural injections assessing their role in disc herniation, spinal stenosis, and axial or discogenic pain. A contemporary, private, specialty referral interventional pain management center in the United States. Cost utility of lumbar interlaminar epidural injections with or without steroids in managing lumbar disc herniation, central spinal stenosis, and discogenic or axial low back pain was conducted with data derived from 3 RCTs that included a 2-year follow-up, with inclusion of 360 patients. The primary outcome was significant improvement defined as at least a 50% in pain reduction and disability status. Direct payment data from 2016 was utilized for assessment of procedural costs. Overall costs, including drug costs, were determined by multiplication of direct procedural payment data by a factor of 1.4 to accommodate for indirect payments respectively for disc herniation, spinal stenosis, discogenic pain. The results of 3 RCTs showed direct cost utility for one year of quality-adjusted life year (QALY) of $2,050.87 for disc herniation, $2,112.25 for axial or discogenic pain without disc herniation

  11. Clinical Outcomes of Posterior Lumbar Interbody Fusion versus Minimally Invasive Transforaminal Lumbar Interbody Fusion in Three-Level Degenerative Lumbar Spinal Stenosis

    PubMed Central

    Fan, Guoxin; Wu, Xinbo; Yu, Shunzhi; Sun, Qi; Zhang, Hailong; Gu, Xin

    2016-01-01

    The aim of this study was to directly compare the clinical outcomes of posterior lumbar interbody fusion (PLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in three-level lumbar spinal stenosis. This retrospective study involved a total of 60 patients with three-level degenerative lumbar spinal stenosis who underwent MIS-TLIF or PLIF from January 2010 to February 2012. Back and leg visual analog scale (VAS), Oswestry Disability Index (ODI), and Short Form-36 (SF-36) scale were used to assess the pain, disability, and health status before surgery and postoperatively. In addition, the operating time, estimated blood loss, and hospital stay were also recorded. There were no significant differences in back VAS, leg VAS, ODI, SF-36, fusion condition, and complications at 12-month follow-up between the two groups (P > 0.05). However, significantly less blood loss and shorter hospital stay were observed in MIS-TLIF group (P < 0.05). Moreover, patients undergoing MIS-TLIF had significantly lower back VAS than those in PLIF group at 6-month follow-up (P < 0.05). Compared with PLIF, MIS-TLIF might be a prior option because of noninferior efficacy as well as merits of less blood loss and quicker recovery in treating three-level lumbar spinal stenosis. PMID:27747244

  12. Minimally Invasive Oblique Lumbar Interbody Fusion with Spinal Endoscope Assistance: Technical Note.

    PubMed

    Heo, Dong Hwa; Choi, Won Suh; Park, Choon-Keun; Kim, Jin-Sung

    2016-12-01

    The purpose of this report is to describe the surgical methodology and effectiveness of minimally invasive oblique lumbar interbody fusion (OLIF) assisted by spinal endoscopy, which can treat disk herniation from the central to contralateral foramen. OLIF showed indirect decompression effects on reduction of spondylolisthesis and a foraminal widening effect on disk height restoration. In this study, the indirect decompression effect of OLIF was augmented by direct endoscopic decompression and spinal endoscopy for removal of herniated disk materials. Twelve patients with confirmed degenerative lumbar stenosis, herniated lumbar disks, and degenerative spondylolisthesis were treated using OLIF with spinal endoscopic discectomy. Direct ventral decompression was achieved by removal of herniated disk materials. The symptoms of all patients improved postoperatively. OLIF with spinal endoscopic discectomy can achieve neural decompression without additional posterior decompression and can be used as an alternative treatment in selected cases. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Management of degenerative lumbar spinal stenosis: an evidence-based review

    PubMed Central

    Covaro, Augusto; Vilà-Canet, Gemma; de Frutos, Ana García; Ubierna, Maite T.; Ciccolo, Francesco; Caceres, Enric

    2016-01-01

    Lumbar spinal stenosis has become one of the most disabling pathologies in the elderly population. Some additional conditions such as foraminal stenosis or degenerative spondylosis with a history of back pain and leg pain must be considered before treatment. A completely appropriate protocol and unified management of spinal stenosis have not yet been well defined. The objective of this literature review is to provide evidence-based recommendations reflected in the highest-quality clinical literature available to address key clinical questions surrounding the management of degenerative lumbar spinal stenosis. Cite this article: Covaro A, Vilà-Canet G, García de Frutos A, Ubierna MT, Ciccolo F, Caceres E. Management of degenerative lumbar spinal stenosis: an evidence-based review article. EFORT Open Rev 2016;1:267-274. DOI: 10.1302/2058-5241.1.000030. PMID:28461958

  14. Surgical versus non-surgical treatment for lumbar spinal stenosis.

    PubMed

    Zaina, Fabio; Tomkins-Lane, Christy; Carragee, Eugene; Negrini, Stefano

    2016-01-29

    Lumbar spinal stenosis (LSS) is a debilitating condition associated with degeneration of the spine with aging. To evaluate the effectiveness of different types of surgery compared with different types of non-surgical interventions in adults with symptomatic LSS. Primary outcomes included quality of life, disability, function and pain. Also, to consider complication rates and side effects, and to evaluate short-, intermediate- and long-term outcomes (six months, six months to two years, five years or longer). We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, five other databases and two trials registries up to February 2015. We also screened reference lists and conference proceedings related to treatment of the spine. Randomised controlled trials (RCTs) comparing surgical versus non-operative treatments in participants with lumbar spinal stenosis confirmed by clinical and imaging findings. For data collection and analysis, we followed methods guidelines of the Cochrane Back and Neck Review Group (Furlan 2009) and those provided in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011). From the 12,966 citations screened, we assessed 26 full-text articles and included five RCTs (643 participants).Low-quality evidence from the meta-analysis performed on two trials using the Oswestry Disability Index (pain-related disability) to compare direct decompression with or without fusion versus multi-modal non-operative care showed no significant differences at six months (mean difference (MD) -3.66, 95% confidence interval (CI) -10.12 to 2.80) and at one year (MD -6.18, 95% CI -15.03 to 2.66). At 24 months, significant differences favoured decompression (MD -4.43, 95% CI -7.91 to -0.96). Low-quality evidence from one small study revealed no difference in pain outcomes between decompression and usual conservative care (bracing and exercise) at three months (risk ratio (RR) 1.38, 95% CI 0.22 to 8.59), four years (RR

  15. Posterior Branches of Lumbar Spinal Nerves - part II: Lumbar Facet Syndrome - Pathomechanism, Symptomatology and Diagnostic Work-up.

    PubMed

    Kozera, Katarzyna; Ciszek, Bogdan; Szaro, Paweł

    2017-04-12

    Posterior branches of the lumbar spinal nerves are the anatomic substrate of pain in the lower back, sacrum and the gluteal area. Such pain may be associated with various pathologies which cause pain in the posterior branches of the lumbar spinal nerves due to entrapment, mechanical irritation or inflammatory reaction and/or degeneration. The posterior branches are of significant functional importance, which is related to the function of the structures they supply, including facet joints, which are the basic biomechanical units of the spine. Low back pain caused by facet joint pathology may be triggered e.g. by simple activities, such as body rotations, unnatural positions, lifting heavy weights or excessive bending as well as chronic overloading with spinal hyperextension. Pain usually presents at the level of the lumbosacral junction (L 5 -S 1 ) and in the lower lumbar spine (L 4-5 , L 3-4 ). In the absence of specific diagnostic criteria, it is only possible to conclude that patients display tenderness at the level of the affected facet joint and that the pain is triggered by extension. Differential diagnosis for low back pain is difficult, since the pain may originate from various structures. The most reliable method of identifying Lumbar Facet Syndrome has been found to be a positive response to an analgesic procedure in the form of a block of the medial branch or intraarticular injection. There appear to be good grounds for conducting further studies and developing unequivocal diagnostic tests.

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

    PubMed Central

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

    2008-01-01

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

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

    PubMed

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

    2008-11-18

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

  18. Stereotactic Radiosurgery for Treatment of Spinal Metastases Recurring in Close Proximity to Previously Irradiated Spinal Cord

    SciTech Connect

    Choi, Clara Y.H.; Adler, John R.; Gibbs, Iris C.; Chang, Steven D.; Jackson, Paul S.; Minn, A. Yuriko; Lieberson, Robert E.; Soltys, Scott G.

    2010-10-01

    Purpose: As the spinal cord tolerance often precludes reirradiation with conventional techniques, local recurrence within a previously irradiated field presents a treatment challenge. Methods and Materials: We retrospectively reviewed 51 lesions in 42 patients treated from 2002 to 2008 whose spinal metastases recurred in a previous radiation field (median previous spinal cord dose of 40 Gy) and were subsequently treated with stereotactic radiosurgery (SRS). Results: SRS was delivered to a median marginal dose of 20 Gy (range, 10-30 Gy) in 1-5 fractions (median, 2), targeting a median tumor volume of 10.3 cm{sup 3} (range, 0.2-128.6 cm{sup 3}). Converting the SRS regimens with the linear quadratic model ({alpha}/{beta} = 3), the median spinal cord maximum single-session equivalent dose (SSED) was 12.1 Gy{sub 3} (range, 4.7-19.3 Gy{sub 3}). With a median follow-up of 7 months (range, 2-47 months), the Kaplan-Meier local control and overall survival rates at 6/12 months were 87%/73% and 81%/68%, respectively. A time to retreatment of {<=}12 months and the combination of time to retreatment of {<=}12 months with an SSED of <15 Gy{sub 10} were significant predictors of local failure on univariate and multivariate analyses. In patients with a retreatment interval of <12 months, 6/12 month local control rates were 88%/58%, with a SSED of >15 Gy{sub 10}, compared to 45%/0% with <15 Gy{sub 10}, respectively. One patient (2%) experienced Grade 4 neurotoxicity. Conclusion: SRS is safe and effective in the treatment of spinal metastases recurring in previously irradiated fields. Tumor recurrence within 12 months may correlate with biologic aggressiveness and require higher SRS doses (SSED >15 Gy{sub 10}). Further research is needed to define the partial volume retreatment tolerance of the spinal cord and the optimal target dose.

  19. Comparison of dynamic posteroanterior spinal stiffness to plain film radiographic images of lumbar disk height.

    PubMed

    Colloca, Christopher J; Keller, Tony S; Peterson, Terry K; Seltzer, Daryn E

    2003-05-01

    Assessments of spinal stiffness have become more popular in recent years as a noninvasive objective biomechanical means to evaluate the human spine. Studies investigating posteroanterior (PA) forces in spinal stiffness assessment have shown relationships to spinal level, body type, and lumbar extensor muscle activity. Such measures may be important determinants to discriminate between patients with low back pain (LBP) and asymptomatic subjects. To determine the relationships between dynamic PA spinal stiffness and radiographic measures of lower lumbar disk height and disk degeneration. L4 and L5 posterior disk height (PDH), vertebral body height (PVH), anterior disk height (ADH), and vertebral body height (AVH) were obtained from digitized plain film anteroposterior (AP) and lateral radiographs of 18 symptomatic LBP patients presenting to a chiropractic office (8 female patients and 10 male patients, aged 15-69 years, mean 44.3, SD 15.4 years). Disk degeneration (DD) and facet arthrosis (FA) were qualitatively assessed from the films by an independent examiner. Anterior disk height ratios (ADHR = ADH/AVH) and posterior disk height ratios (PDHR = PDH/PVH) were calculated from the disk height measurements and were compared to L4 and L5 posteroanterior spinal stiffness obtained using a previously validated mechanical impedance stiffness assessment procedure. One third of the subjects were found to have radiographic evidence of mild or moderate DD and approximately two thirds of the subjects showed signs of mild or moderate FA. The L4 and L5 anterior disk height and posterior disk height were approximately one half and one fifth of the respective vertebral body heights, and the PA stiffness was greater at L4 than at L5. Male subjects had a greater ADHR than female subjects, but female subjects had a greater L4 and L5 PA stiffness in comparison to male subjects; however, these differences were not statistically significant. Posteroanterior L5 vertebral stiffness was

  20. Increasing lumbar lordosis of adult spinal deformity patients via intraoperative prone positioning.

    PubMed

    Harimaya, Katsumi; Lenke, Lawrence G; Mishiro, Takuya; Bridwell, Keith H; Koester, Linda A; Sides, Brenda A

    2009-10-15

    A retrospective evaluation. To evaluate the change in lumbar lordosis in spinal deformity patients who underwent an instrumented posterior spinal fusion on the Orthopedic Systems Inc. (OSI) "Jackson" frame. Intraoperative prone positioning with hip extension may posturally increase lumbar lordosis during adult spinal deformity reconstructive surgery, as has been shown in adult lumbar degenerative surgery. Radiographs of 44 operative spinal deformity patients (43 females/1 male; mean age, 57.4 years) were analyzed. Diagnoses included idiopathic scoliosis (29), degenerative lumbar scoliosis (9), and other (6). Total lumbar lordosis (T12-S1), segmental disc angles, and C7 plumbline were measured on preoperative upright and supine, intraoperative prone, and postoperative upright lateral radiographs. All patients were positioned intraoperatively with hip extension on the OSI frame. Average preoperative upright and supine, intraoperative prone, and postoperative upright lumbar lordosis (T12-SAC) measurements were -38.1 degrees, -46.0 degrees, -46.2 degrees, and -51.8 degrees, respectively (P < 0.05 for preoperative upright to all other comparisons). Two groups were noted: those with increased lumbar lordosis (>5 degrees) during intraoperative prone positioning (n = 25, increased lordosis group) as compared to the preoperative measurement versus those with minimal to no change in lordosis (< or =5 degrees) during intraoperative prone positioning (n = 19, unchanged lordosis group). The corresponding lumbar lordosis measurements for the increased lordosis group were -25.9 degrees, -40.0 degrees, -43.1 degrees, and -48.9 degrees (P < 0.05 for preoperative upright to all other comparisons). The corresponding lumbar lordosis measurements for the unchanged lordosis group were -54.2 degrees, -53.8 degrees, -50.3 degrees, and -55.7 degrees (no significant differences). Preoperative upright lumbar lordosis in the unchanged lordosis group was substantially higher than increased

  1. Cost analysis of spinal and general anesthesia for the surgical treatment of lumbar spondylosis.

    PubMed

    Walcott, Brian P; Khanna, Arjun; Yanamadala, Vijay; Coumans, Jean-Valery; Peterfreund, Robert A

    2015-03-01

    Lumbar spine surgery is typically performed under general anesthesia, although spinal anesthesia can also be used. Given the prevalence of lumbar spine surgery, small differences in cost between the two anesthetic techniques have the potential to make a large impact on overall healthcare costs. We sought to perform a cost comparison analysis of spinal versus general anesthesia for lumbar spine operations. Following Institutional Review Board approval, a retrospective cohort study was performed from 2009-2012 on consecutive patients undergoing non-instrumented, elective lumbar spine surgery for spondylosis by a single surgeon. Each patient was evaluated for both types of anesthesia, with the decision for anesthetic method being made based on a combination of physical status, anatomical considerations, and ultimately a consensus agreement between patient, surgeon, and anesthesiologist. Patient demographics and clinical characteristics were compared between the two groups. Operating room costs were calculated whilst blinded to clinical outcomes and reported in percentage difference. General anesthesia (n=319) and spinal anesthesia (n=81) patients had significantly different median operative times of 175 ± 39.08 and 158 ± 32.75 minutes, respectively (p<0.001, Mann-Whitney U test). Operating room costs were 10.33% higher for general anesthesia compared to spinal anesthesia (p=0.003, Mann-Whitney U test). Complications of spinal anesthesia included excessive movement (n=1), failed spinal attempt (n=3), intraoperative conversion to general anesthesia (n=2), and a high spinal level (n=1). In conclusion, spinal anesthesia can be performed safely in patients undergoing lumbar spine surgery. It has the potential to reduce operative times, costs, and possibly, complications. Further prospective evaluation will help to validate these findings.

  2. Paraplegia due to Missed Thoracic Meningioma after Laminotomy for Lumbar Spinal Stenosis: Report of Two Cases

    PubMed Central

    Lee, Sang-Wook; Shim, Jung-Hyun

    2011-01-01

    To describe two cases of thoracic paraplegia due to a thoracic spinal cord tumor (meningioma) that was not detected during lumbar spinal decompressive surgery for lumbar canal stenosis and a complaint of claudication. The follow-up period ranged from 1 year and 6 months to 1 year and 8 months. The neurological deficit due to thoracic meningioma after surgery for lumbar canal stensois was decreased after mass excision. So, careful physical examination and magnetic resonance imaging can reveal another thoracic spine compressive lesion such as meningioma. Additional thoracic decompressive surgery can provide partial amelioration of each patient's neurological condition. Surgeons should know that a silent meningioma can aggrevate neurological symptoms after lower lumbar spine surgery and should inform their patient before surgery. PMID:22164321

  3. Paraplegia due to Missed Thoracic Meningioma after Laminotomy for Lumbar Spinal Stenosis: Report of Two Cases.

    PubMed

    Ko, Sang-Bong; Lee, Sang-Wook; Shim, Jung-Hyun

    2011-12-01

    To describe two cases of thoracic paraplegia due to a thoracic spinal cord tumor (meningioma) that was not detected during lumbar spinal decompressive surgery for lumbar canal stenosis and a complaint of claudication. The follow-up period ranged from 1 year and 6 months to 1 year and 8 months. The neurological deficit due to thoracic meningioma after surgery for lumbar canal stensois was decreased after mass excision. So, careful physical examination and magnetic resonance imaging can reveal another thoracic spine compressive lesion such as meningioma. Additional thoracic decompressive surgery can provide partial amelioration of each patient's neurological condition. Surgeons should know that a silent meningioma can aggrevate neurological symptoms after lower lumbar spine surgery and should inform their patient before surgery.

  4. Transforaminal epidural steroid injection in lumbar spinal stenosis: an observational study with two-year follow-up.

    PubMed

    Davis, Niel; Hourigan, Patrick; Clarke, Andrew

    2017-04-01

    Transforaminal epidural steroid injection (TFESI) is recognised as a treatment for symptomatic lumbar disc herniation, whilst surgical decompression is generally thought to be the most effective treatment option for lumbar spinal stenosis. There is little available literature examining the effect of TFESI on symptomatic lumbar spinal stenosis. To evaluate the use of TFESI as an alternative to surgery in patients with symptomatic stenosis. An observational study which took place between May 2010 and July 2013. All patients were seen by the Extended Scope Physiotherapist (ESP) injection service. A total of 68 consecutive patients were included. Thirty-one were male and 37 were female. The average age was 75 years. The primary outcome measure was the avoidance of decompressive surgery. Patients with radicular leg pain were seen by an ESP in an Outpatient setting. Concordant clinical examination and magnetic resonance imaging were required for diagnosis. Peri-radicular bupivacaine hydrochloride 0.25% (3 ml) and triamcinolone (40 mg) were then injected. Outcome measures were recorded at 6 weeks, 1 year and 2 years. Of 68 patients with spinal stenosis, 22 (32%) had opted for surgery at two year follow-up. Thirty (44%) patients were satisfied with non-surgical management at 2 years, required no further treatment, and were discharged. Of the remaining 24%, nine patients were referred for further injection, four declined surgery but were referred to the Pain Relief Clinic, two still had a similar level of pain but declined surgery and one had died. Our study reports a considerably lower percentage patients opting for surgery than previously demonstrated by the available literature. TFESI is a reasonable treatment for lumbar spinal stenosis and can result in long-term relief from symptoms in a high proportion of patients.

  5. Randomised placebo-controlled trial on the effectiveness of nasal salmon calcitonin in the treatment of lumbar spinal stenosis.

    PubMed

    Tafazal, Suhayl I; Ng, Leslie; Sell, Philip

    2007-02-01

    This is a double blind randomised controlled trial to assess the effectiveness of nasal salmon calcitonin in the treatment of lumbar spinal stenosis. The trial compared the outcome of salmon calcitonin nasal spray to placebo nasal spray in patients with MRI confirmed lumbar spinal stenosis. Lumbar spinal stenosis is one of the commonest conditions encountered by spine surgeons. It more frequently affects elderly patients and lumbar decompression has been used to treat the condition with variable success. Non operative measures have been investigated, but their success ranges from 15% to 43% in patients followed up for 1-5 years (Simotas in Clin Orthop 1(384):153-161, 2001). Salmon calcitonin injections have been investigated in previous trials and may have a treatment effect. Nasal salmon calcitonin has become available and if effective would have advantages over injections. Forty patients with symptoms of neurogenic claudication and MRI proven lumbar spinal stenosis were randomly assigned either nasal salmon calcitonin or placebo nasal spray to use for 4 weeks. This was followed by a 'washout' period of 6 weeks, and subsequent treatment with 6 weeks of nasal salmon calcitonin. Standard spine outcome measures including Oswestry disability index (ODI), low back outcome score, visual analogue score and shuttle walking test were administered at baseline, 4, 10 and 16 weeks. Twenty patients received nasal salmon calcitonin and twenty patients received placebo nasal spray. At 4 weeks post treatment there was no statistically significant difference in the outcome measures between the two groups. The change in ODI was a mean 1.3 points for the calcitonin group and 0.6 points for the placebo group (P = 0.51), the mean change in visual analogue score for leg pain was 10 mm in the calcitonin group and 0 mm in the placebo group (P = 0.51). There was no significant difference in walking distance between the two groups, with a mean improvement in walking distance of 21 m in the

  6. Infected lumbar dermoid cyst mimicking intramedullary spinal cord tumor: Observations and outcomes

    PubMed Central

    Vadivelu, Sudhakar; Desai, Sohum K.; Illner, Anna; Luerssen, Thomas G.; Jea, Andrew

    2014-01-01

    We report two unusual cases of a 17-month-old boy with a previously undiagnosed lumbar dermal sinus tract terminating in an intradural dermoid cyst and holocord edema or syrinx, presenting with paraparesis and sphincter dysfunction secondary to an intramedullary abscess and a 26-month-old boy with a previously undiagnosed lumbar dermal sinus tract terminating in an infected dermoid cyst and intramedullary abscess, presenting with recurrent episodes of meningitis and hydrocephalus. Pre-operative magnetic resonance imaging (MRI) studies in these patients were initially confused for an intramedullary spinal cord tumor; however, the presence of an associated dermal sinus tract made this diagnosis of neoplasm less likely. Total excision of the dermal sinus tract, debulking of the dermoid cyst and drainage of the intramedullary abscess through an L1-L5 osteoplastic laminoplasty and midline myelotomy, followed by long-term antibiotic therapy resulted in a good functional recovery. Post-operative MRI of the spine showed removal of the dermoid cyst, decreased inflammatory granulation tissue and resolution of the holocord edema or syrinx. We also performed a literature review to determine the cumulative experience of management of intramedullary abscess in this rare clinical setting. PMID:24891897

  7. Current trends in spinal arthroplasty: an assessment of surgeon practices and attitudes regarding cervical and lumbar disk replacement.

    PubMed

    Whang, Peter G; Simpson, Andrew K; Rechtine, Glenn; Grauer, Jonathan N

    2009-02-01

    Survey study involving orthopedic and neurosurgical spine surgeons. To report the current practices and opinions of spine surgeons regarding cervical and lumbar total disk arthroplasty (TDA) as alternatives to arthrodesis for the treatment of degenerative conditions of the spine. TDA represents an alternative surgical treatment for degenerative spinal conditions that may avoid the deleterious effects associated with fusion. Unfortunately, the prevailing opinions of surgeons about TDA have not been well characterized and the patterns of its utilization have not been documented previously in the literature. A questionnaire was developed to record the attitudes of spine surgeons regarding cervical and lumbar TDA and to assess their utilization of this technology. This survey was distributed to all of the surgeons attending the 2007 "Contemporary Update on Disorders of the Spine" meeting in Whistler, British Columbia. One hundred thirteen of the 133 surgeons present at the meeting completed the questionnaire, corresponding to a return rate of 85%. The percentage of surgeons who had performed lumbar TDA was significantly higher than that for cervical TDA (42% vs. 30%, P=0.05). However, 81% of respondents stated that they were more likely to perform cervical TDA now compared with 1 year ago, whereas 64% indicated that they were less likely to perform lumbar TDA. The most frequently cited reasons for not performing both cervical and lumbar TDA were questions concerning long-term outcomes and perceived difficulties with obtaining financial compensation from insurance companies; in addition, surgeons were also concerned about revising lumbar TDA cases. Although the results of this study confirm that the enthusiasm for TDA was shared by many of these respondents, it is clear that additional long-term, prospective, comparative data are required before this technology may be considered as a replacement for more traditional spinal fusion procedures.

  8. Nursing Review Section of Surgical Neurology International Part 2: Lumbar Spinal Stenosis.

    PubMed

    Epstein, Nancy E; Hollingsworth, Renee D

    2017-01-01

    The lumbar spine includes 5 lumbar vertebral bodies, L1, L2, L3, L4, and L5. At each level, there is a disc space defined by the two bones (vertebral bodies) in the back; for example, there is a disc space at the L5-S1 level etc. The normal front to back (anterior to posterior or AP diameter) measurement of the spinal canal is typically 18-20 mm, but some patients have narrowing called spinal stenosis. Lumbar stenosis is defined by two major types. Central stenosis compresses the midline (in the middle) sac of nerve tissue (dural or thecal sac containing the lumbar nerve roots). Lateral recess stenosis (off to the sides) compresses the individual exiting nerve roots. At each lumbar level, there may be compression of the nerve tissue centrally (dura also called cauda equina) or the nerve roots (on one or both sides). Compression may occur due to soft or calcified discs in the front (anteriorly) of the spine at different levels or from behind (posteriorly) due to arthritic enlargement (hypertrophy) or calcification (ossification) of the yellow ligament, facet joints, and/or bones (laminae). Surgery to remove bone and arthritic structures from the back of the spinal canal to decompress nerve tissue is called a laminectomy. Patients with narrowing of the lumbar spinal canal may have central or lateral recess stenosis that compresses the thecal sac and/or exiting nerve roots at any of 5 levels. Laminectomy, performed at single or multiple levels, decompresses lumbar spinal stenosis.

  9. Nursing Review Section of Surgical Neurology International Part 2: Lumbar Spinal Stenosis

    PubMed Central

    Epstein, Nancy E.; Hollingsworth, Renee D.

    2017-01-01

    Background: The lumbar spine includes 5 lumbar vertebral bodies, L1, L2, L3, L4, and L5. At each level, there is a disc space defined by the two bones (vertebral bodies) in the back; for example, there is a disc space at the L5-S1 level etc. The normal front to back (anterior to posterior or AP diameter) measurement of the spinal canal is typically 18-20 mm, but some patients have narrowing called spinal stenosis. Methods: Lumbar stenosis is defined by two major types. Central stenosis compresses the midline (in the middle) sac of nerve tissue (dural or thecal sac containing the lumbar nerve roots). Lateral recess stenosis (off to the sides) compresses the individual exiting nerve roots. Results: At each lumbar level, there may be compression of the nerve tissue centrally (dura also called cauda equina) or the nerve roots (on one or both sides). Compression may occur due to soft or calcified discs in the front (anteriorly) of the spine at different levels or from behind (posteriorly) due to arthritic enlargement (hypertrophy) or calcification (ossification) of the yellow ligament, facet joints, and/or bones (laminae). Surgery to remove bone and arthritic structures from the back of the spinal canal to decompress nerve tissue is called a laminectomy. Conclusions: Patients with narrowing of the lumbar spinal canal may have central or lateral recess stenosis that compresses the thecal sac and/or exiting nerve roots at any of 5 levels. Laminectomy, performed at single or multiple levels, decompresses lumbar spinal stenosis. PMID:28781916

  10. Effects of calcitonin on lumbar spinal stenosis: a systematic review and meta-analysis

    PubMed Central

    Peng, Kun; Chen, Long; Peng, Jing; Xing, Fei; Xiang, Zhou

    2015-01-01

    Background: To investigate whether calcitonin can improve walking distance (WD) and visual analog pain scale (VAS) in patients who suffer lumbar spinal stenosis (LSS). Methods: We performed a search on CENTRAL, PubMed, Embase and Cochrane databases up to July 2014; we finally found 19 original articles, of which only 6 were in full compliance with the RCT criteria. These full articles were carefully reviewed independent and in blinded way by two previously capacitated reviewers for the objective to extract data and score a quality of these articles by the criteria of Cochrane Handbook (5.1.0). Results: We accepted 6 studies with 232 participants. There is no evidence show calcitonin is better than placebo or paracetamol regardless of mode of administration. Conclusions: This meta-analysis suggest that calcitonin provide no significant improvement in pain symptoms or walking distance in LSS patients. PMID:25932199

  11. Spinal stimulation of the upper lumbar spinal cord modulates urethral sphincter activity in rats after spinal cord injury.

    PubMed

    Abud, Edsel M; Ichiyama, Ronaldo M; Havton, Leif A; Chang, Huiyi H

    2015-05-01

    After spinal cord injury (SCI), the neurogenic bladder is observed to develop asynchronous bladder and external urethral sphincter (EUS) contractions in a condition known as detrusor-sphincter dyssnergia (DSD). Activation of the EUS spinal controlling center located at the upper lumbar spinal cord may contribute to reduce EUS dyssynergic contractions and decrease urethral resistance during voiding. However, this mechanism has not been well studied. This study aimed at evaluating the effects of epidural stimulation (EpS) over the spinal EUS controlling center (L3) in combination with a serotonergic receptor agonist on EUS relaxation in naive rats and chronic (6-8 wk) T8 SCI rats. Cystometrogram and EUS electromyography (EMG) were obtained before and after the intravenous administration of 5HT-1A receptor agonist and antagonist. The latency, duration, frequency, amplitude, and area under curve of EpS-evoked EUS EMG responses were analyzed. EpS on L3 evoked an inhibition of EUS tonic contraction and an excitation of EUS intermittent bursting/relaxation correlating with urine expulsion in intact rats. Combined with a 5HT-1A receptor agonist, EpS on L3 evoked a similar effect in chronic T8 SCI rats to reduce urethral contraction (resistance). This study examined the effect of facilitating the EUS spinal controlling center to switch between urine storage and voiding phases by using EpS and a serotonergic receptor agonist. This novel approach of applying EpS on the EUS controlling center modulates EUS contraction and relaxation as well as reduces urethral resistance during voiding in chronic SCI rats with DSD.

  12. Classifying patients with lumbar spinal stenosis using painDETECT: a cross-sectional study.

    PubMed

    Takahashi, Naoto; Shirado, Osamu; Kobayashi, Kazuki; Mashiko, Ryosuke; Konno, Shin-Ichi

    2016-07-22

    The pathological mechanisms of lumbar spinal stenosis are unclear. Family doctors in the primary care setting may perform medical examinations of patients with lumbar spinal stenosis. Our aim was to use the painDETECT questionnaire to quantify the pathological mechanisms of low back pain and/or leg pain caused by lumbar spinal stenosis. We enrolled 102 patients (37 men, 65 women) who had been newly diagnosed with lumbar spinal stenosis at 2 facilities. The patients' conditions were evaluated using the painDETECT questionnaire, Numerical Rating Scale, Roland-Morris Disability Questionnaire, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, and 36-Item Short-Form Health Survey. The pathological mechanisms of low back pain and/or leg pain caused by lumbar spinal stenosis were classified based on results of the painDETECT questionnaire as nociceptive pain, neuropathic pain, or unclear type of pain (mixed pain). Statistical analyses were performed using the Kruskal-Wallis test. A value of p < 0.05 was considered to indicate statistical significance. The mean age of all patients in this study was 70.3 ± 2 years. The male:female distribution was 37:65 (36.3:63.7 %). In all, 72 (70.6 %) patients had chronic pain (duration of ≥3 months), and 30 (29.4 %) had subacute or acute pain (duration of <3 months). The pain was classified as nociceptive in 59 patients (57.9 %), neuropathic in 18 (17.6 %), and unclear in 25 (24.5 %). The neuropathic pain group had a significantly lower quality of life (p < 0.05) than did the other groups. Patients with neuropathic back and/or leg pain caused by lumbar spinal stenosis may have lower physical and/or psychological quality of life than patients with such pain caused by other mechanisms.

  13. Full-endoscopic interlaminar removal of chronic lumbar epidural hematoma after spinal manipulation

    PubMed Central

    Cheng, Yen-Po; Lee, Kwo-Whei; Lin, Ping-Yi; Huang, Abel Po-Hao; Cheng, Chun-Yuan; Ma, Hsin-I; Chen, Chien-Min; Hueng, Dueng-Yuan

    2014-01-01

    Background: Spinal manipulation is widely used for low back pain treatments. Complications associated with spinal manipulation are seen. Lumbar epidural hematoma (EDH) is one of the complications reported in the literature. If lumbar chronic EDH symptoms are present, which are similar to those of a herniated nucleus pulposus, surgery may be considered if medical treatment fails. Percutaneous endoscopic discectomy utilizing an interlaminar approach can be successfully applied to those with herniated nucleus pulposus. We use the same technique to remove the lumbar chronic EDH, which is the first documented report in the related literature. Methods: We present a case with chronic lumbar EDH associated with spinal manipulation. Neurologic deficits were noted on physical examination. We arranged for a full-endoscopic interlaminar approach to remove the hematoma for the patient with the rigid endoscopy (Vertebris system; Richard Wolf, Knittlingen, Germany). Results: After surgery, the patient's radiculopathy immediately began to disappear. Magnetic resonance imaging (MRI) follow-up 10 days after the surgery revealed no residual hematoma. No complications were noted during the outpatient department follow up. Conclusions: Lumbar EDH is a possible complication of spinal manipulation. Patient experiencing rapidly progressive neurologic deficit require early surgical evacuation, while conservative treatment may only be applied to those with mild symptoms. A percutaneous full-endoscopic interlaminar approach may be a viable alternative for the treatment of those with chronic EDH with progressive neurologic deficits. PMID:24872917

  14. Study Protocol- Lumbar Epidural Steroid Injections for Spinal Stenosis (LESS): a double-blind randomized controlled trial of epidural steroid injections for lumbar spinal stenosis among older adults

    PubMed Central

    2012-01-01

    Background Lumbar spinal stenosis is one of the most common causes of low back pain among older adults and can cause significant disability. Despite its prevalence, treatment of spinal stenosis symptoms remains controversial. Epidural steroid injections are used with increasing frequency as a less invasive, potentially safer, and more cost-effective treatment than surgery. However, there is a lack of data to judge the effectiveness and safety of epidural steroid injections for spinal stenosis. We describe our prospective, double-blind, randomized controlled trial that tests the hypothesis that epidural injections with steroids plus local anesthetic are more effective than epidural injections of local anesthetic alone in improving pain and function among older adults with lumbar spinal stenosis. Methods We will recruit up to 400 patients with lumbar central canal spinal stenosis from at least 9 clinical sites over 2 years. Patients with spinal instability who require surgical fusion, a history of prior lumbar surgery, or prior epidural steroid injection within the past 6 months are excluded. Participants are randomly assigned to receive either ESI with local anesthetic or the control intervention (epidural injections with local anesthetic alone). Subjects receive up to 2 injections prior to the primary endpoint at 6 weeks, at which time they may choose to crossover to the other intervention. Participants complete validated, standardized measures of pain, functional disability, and health-related quality of life at baseline and at 3 weeks, 6 weeks, and 3, 6, and 12 months after randomization. The primary outcomes are Roland-Morris Disability Questionnaire and a numerical rating scale measure of pain intensity at 6 weeks. In order to better understand their safety, we also measure cortisol, HbA1c, fasting blood glucose, weight, and blood pressure at baseline, and at 3 and 6 weeks post-injection. We also obtain data on resource utilization and costs to assess cost

  15. A database of lumbar spinal mechanical behavior for validation of spinal analytical models.

    PubMed

    Stokes, Ian A F; Gardner-Morse, Mack

    2016-03-21

    Data from two experimental studies with eight specimens each of spinal motion segments and/or intervertebral discs are presented in a form that can be used for comparison with finite element model predictions. The data include the effect of compressive preload (0, 250 and 500N) with quasistatic cyclic loading (0.0115Hz) and the effect of loading frequency (1, 0.1, 0.01 and 0.001Hz) with a physiological compressive preload (mean 642N). Specimens were tested with displacements in each of six degrees of freedom (three translations and three rotations) about defined anatomical axes. The three forces and three moments in the corresponding axis system were recorded during each test. Linearized stiffness matrices were calculated that could be used in multi-segmental biomechanical models of the spine and these matrices were analyzed to determine whether off-diagonal terms and symmetry assumptions should be included. These databases of lumbar spinal mechanical behavior under physiological conditions quantify behaviors that should be present in finite element model simulations. The addition of more specimens to identify sources of variability associated with physical dimensions, degeneration, and other variables would be beneficial. Supplementary data provide the recorded data and Matlab® codes for reading files. Linearized stiffness matrices derived from the tests at different preloads revealed few significant unexpected off-diagonal terms and little evidence of significant matrix asymmetry.

  16. Quantitative radiologic criteria for the diagnosis of lumbar spinal stenosis: a systematic literature review

    PubMed Central

    2011-01-01

    Background Beside symptoms and clinical signs radiological findings are crucial in the diagnosis of lumbar spinal stenosis (LSS). We investigate which quantitative radiological signs are described in the literature and which radilogical criteria are used to establish inclusion criteria in clincical studies evaluating different treatments in patients with lumbar spinal stenosis. Methods A literature search was performed in Medline, Embase and the Cochrane library to identify papers reporting on radiological criteria to describe LSS and systematic reviews investigating the effects of different treatment modalities. Results 25 studies reporting on radiological signs of LSS and four systematic reviews related to the evaluation of different treatments were found. Ten different parameters were identified to quantify lumbar spinal stenosis. Most often reported measures for central stenosis were antero-posterior diameter (< 10 mm) and cross-sectional area (< 70 mm2) of spinal canal. For lateral stenosis height and depth of the lateral recess, and for foraminal stenosis the foraminal diameter were typically used. Only four of 63 primary studies included in the systematic reviews reported on quantitative measures for defining inclusion criteria of patients in prognostic studies. Conclusions There is a need for consensus on well-defined, unambiguous radiological criteria to define lumbar spinal stenosis in order to improve diagnostic accuracy and to formulate reliable inclusion criteria for clinical studies. PMID:21798008

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

    PubMed

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

    2011-03-01

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

  18. Spinal canal morphology and clinical outcomes of microsurgical bilateral decompression via a unilateral approach for lumbar spinal canal stenosis.

    PubMed

    Choi, Won-Seok; Oh, Chang Hyun; Ji, Gyu Yeul; Shin, Sung Chan; Lee, Jang-Bo; Park, Dong-Hyuk; Cho, Tai-Hyoung

    2014-05-01

    Microsurgical bilateral decompression via a unilateral approach for lumbar spinal stenosis is a less invasive technique compared to conventional laminectomy. Although many technical reports have demonstrated acceptable overall surgical outcomes for this approach, no studies have attempted to clarify the clinical outcomes thereof in regard to anatomical variance of the spinal canal. This study was conducted to analyze the clinical outcomes of microsurgical bilateral decompression via a unilateral approach according to spinal canal morphology in degenerative lumbar spinal stenosis. Between January 2008 and December 2009, 144 patients with single-level spinal lumbar stenosis underwent microsurgical bilateral decompression via a unilateral approach by a single surgeon. Patients were categorized into three groups according to spinal canal shape: round (n = 42), oval (n = 36), and trefoil (n = 66), and clinical parameters were assessed both before and after surgery with 2-3 years of follow-up. Mean visual analog scale (VAS) and Oswestry disability index (ODI) decreased after surgery, respectively, from 8.1 and 59.8 % to 2.1 and 19.1 % in the round shaped spinal canal group, from 7.2 and 47.1 % to 2.2 and 15.1 % in the oval shaped spinal canal group, and from 6.8 and 53.6 % to 3.6 and 33.3 % in the trefoil shaped spinal canal group. In all groups, VAS and ODI scores significantly improved postoperatively (p < 0.01), although less improved VAS and ODI scores were observed in the trefoil shaped spinal canal group (p < 0.01). The overall patient satisfaction rate was 66.7 %; however, statistically significant lower satisfaction rates were reported in the trefoil shaped spinal canal group (p < 0.01). Microsurgical bilateral decompression via a unilateral approach may be a good modality for treating round or oval shape spinal canal stenosis, but is not recommended for trefoil-shaped-stenosis. The current authors recommend performing the bilateral

  19. Microscopic lumbar spinal stenosis decompression: is surgical education safe?

    PubMed

    Joswig, Holger; Hock, Carolin; Hildebrandt, Gerhard; Schaller, Karl; Stienen, Martin N

    2016-02-01

    Acquiring operative skills in the course of a structured neurosurgery residency training program is vital to safely operating on patients autonomously upon board certification. We tested the hypothesis that the complication rates and outcome of microscopic lumbar spinal stenosis (LSS) decompression done by supervised residents are not inferior to those of board-certified faculty neurosurgeons (BCFNs). Retrospective single-center study performed at a Swiss teaching hospital comparing consecutive patients undergoing surgery for LSS by a supervised neurosurgery resident (teaching cases) to a consecutive series of patients operated on by a BCFN (non-teaching cases). The primary endpoint was occurrence of complications during surgery. Secondary endpoints were patients' clinical outcomes 4 weeks after surgery, categorized into a binary responder and non-responder variable, occurrence of postoperative complications, need for re-do surgery, and clinical outcome until the last follow-up (FU). In a total of n = 471 operations, n = 194 (41.2 %) were teaching cases and n = 277 (58.8 %) non-teaching cases. A longer operation time (single-level procedures: mean 100.0 vs. 83.2 min, p < 0.001) was recorded for teaching cases, while estimated blood loss was equal (single-level procedures: mean 109.9 vs. 117.0 ml, p = 0.409). In multivariate analysis, supervised residents were as likely as BCFNs to have an intraoperative complication (OR 0.92, 95 % CI 0.41-2.04, p = 0.835). They were as likely as BCFNs to achieve a favorable 4-week response to surgery (OR 1.82, 95 % CI 0.79-4.15, p = 0.155). Until final FU, the likelihood for patients in the teaching group to suffer from postoperative complications (OR 1.07, 95 % CI 0.46-2.49, p = 0.864) or require re-do surgery (OR 0.68, 95 % CI 0.31-1.52, p = 0.358) was similar to that of the non-teaching group. Complication rates and short- and mid-term outcomes following LSS decompression were comparable for

  20. When is compensation for lumbar spinal stenosis a clinical sagittal plane deformity?

    PubMed

    Buckland, Aaron J; Vira, Shaleen; Oren, Jonathan H; Lafage, Renaud; Harris, Bradley Y; Spiegel, Matthew A; Diebo, Bassel G; Liabaud, Barthelemy; Protopsaltis, Themistocles S; Schwab, Frank J; Lafage, Virginie; Errico, Thomas J; Bendo, John A

    2016-08-01

    Degenerative lumbar stenosis (DLS) patients have been reported to lean forward in an attempt to provide neural decompression. Spinal alignment in patients with DLS may resemble that of adult spinal deformity (ASD). No previous studies have compared and contrasted the compensatory mechanisms of DLS and ASD patients. This study aimed to determine the differences in compensatory mechanisms between DLS and ASD patients with increasing severity of sagittal spinopelvic malalignment. Contrasting these compensatory mechanisms may help determine at what severity sagittal malalignment represents a clinical sagittal deformity rather than a compensation for neural compression. This is a retrospective clinical and radiological review. Baseline x-rays in patients without spinal instrumentation, with the clinical radiological and diagnoses of DLS or ASD, were assessed for patterns of spinopelvic compensatory mechanisms. Patients were stratified by sagittal vertical axis (SVA) according to the Scoliosis Research Society-Schwab [SRS-Schwab] classification. Radiographic spinopelvic parameters were measured in the DLS and ASD groups, including SVA, pelvic incidence-lumbar lordosis mismatch (PI-LL), T1 spinopelvic inclination (T1SPi), T1 pelvic angle (TPA), and pelvic tilt (PT). The two diagnosis cohorts were propensity-matched for PI and age. Each group contained 125 patients and was stratified according to the SRS-Schwab classification. Regional spinopelvic,lower limb, and global alignment parameters were assessed to identify differences in compensatory mechanisms between the two groups with differing degrees of deformity. No funding was provided by any third party in relation to carrying out this study or preparing the manuscript. With mild to moderate malalignment (SRS-Schwab groups "0," or "+" for PT, PI-LL, or SVA), DLS patients permit anterior truncal inclination and recruit posterior pelvic shift instead of pelvic tilt to maintain balance, while providing relief of neurologic

  1. Lumbar Scoliosis Combined Lumbar Spinal Stenosis and Herniation Diagnosed Patient Was Treated with “U” Route Transforaminal Percutaneous Endoscopic Lumbar Discectomy

    PubMed Central

    Zhang, Shaobo; Lian, Qingquan; Yan, Haibo; Lin, Xianfa

    2017-01-01

    The objective was to report a case of a 63-year-old man with a history of low back pain (LBP) and left leg pain for 2 years, and the symptom became more serious in the past 5 months. The patient was diagnosed with lumbar scoliosis combined with lumbar spinal stenosis (LSS) and lumbar disc herniation (LDH) at the level of L4-5 that was confirmed using Computerized Topography and Magnetic Resonance Imaging. The surgical team preformed a novel technique, “U” route transforaminal percutaneous endoscopic lumbar discectomy (PELD), which led to substantial, long-term success in reduction of pain intensity and disability. After removing the osteophyte mass posterior to the thecal sac at L4-5, the working channel direction was changed to the gap between posterior longitudinal ligament and thecal sac, and we also removed the herniation and osteophyte at L3-4 with “U” route PELD. The patient's symptoms were improved immediately after the surgical intervention; low back pain intensity decreased from preoperative 9 to postoperative 2 on a visual analog scale (VAS) recorded at 1 month postoperatively. The success of the intervention suggests that “U” route PELD may be a feasible alternative to treat lumbar scoliosis with LSS and LDH patients. PMID:28203471

  2. The Prognostic Importance of Patient Pre-Operative Expectations of Surgery for Lumbar Spinal Stenosis.

    ERIC Educational Resources Information Center

    Iversen, Maura D.; Daltroy, Lawren H.; Fossel, Anne H.; Katz, Jeffrey N.

    1998-01-01

    Examines patients (N=257) with lumbar spinal stenosis preoperatively and at six months to relate patient expectation to baseline function and pain and to determine how patient expectations and preoperative function interact to predict postoperative outcomes. Results show that patients with many preoperative expectations, particularly those with…

  3. The Prognostic Importance of Patient Pre-Operative Expectations of Surgery for Lumbar Spinal Stenosis.

    ERIC Educational Resources Information Center

    Iversen, Maura D.; Daltroy, Lawren H.; Fossel, Anne H.; Katz, Jeffrey N.

    1998-01-01

    Examines patients (N=257) with lumbar spinal stenosis preoperatively and at six months to relate patient expectation to baseline function and pain and to determine how patient expectations and preoperative function interact to predict postoperative outcomes. Results show that patients with many preoperative expectations, particularly those with…

  4. An in vitro spinal cord slice preparation for recording from lumbar motoneurons of the adult mouse.

    PubMed

    Mitra, Pratip; Brownstone, Robert M

    2012-01-01

    The development of central nervous system slice preparations for electrophysiological studies has led to an explosion of knowledge of neuronal properties in health and disease. Studies of spinal motoneurons in these preparations, however, have been largely limited to the early postnatal period, as adult motoneurons are vulnerable to the insults sustained by the preparation. We therefore sought to develop an adult spinal cord slice preparation that permits recording from lumbar motoneurons. To accomplish this, we empirically optimized the composition of solutions used during preparation in order to limit energy failure, reduce harmful ionic fluxes, mitigate oxidative stress, and prevent excitotoxic cell death. In addition to other additives, this involved the use of ethyl pyruvate, which serves as an effective nutrient and antioxidant. We also optimized and incorporated a host of previously published modifications used for other in vitro preparations, such as the use of polyethylene glycol. We provide an in-depth description of the preparation protocol and discuss the rationale underlying each modification. By using this protocol, we obtained stable whole cell patch-clamp recordings from identified fluorescent protein-labeled motoneurons in adult slices; here, we describe the firing properties of these adult motoneurons. We propose that this preparation will allow further studies of how motoneurons integrate activity to produce adult motor behaviors and how pathological processes such as amyotrophic lateral sclerosis affect these neurons.

  5. Acute Paraplegia After Lumbar Steroid Injection in Patients With Spinal Dural Arteriovenous Fistulas: Case Reports

    PubMed Central

    2016-01-01

    Spinal dural arteriovenous fistulas (SDAVFs) are the most common type of spinal vascular malformations. However, SDAVFs are still underdiagnosed entities because their clinical symptoms are usually non-specific, as they include low back pain or radiating pain to the limb. There have been several reports of acute paraplegia after lumbar epidural steroid injections in patients with SDAVFs. We present 4 patients with SDAVFs who received lumbar steroid injection. Among the 4 cases, acute paraplegia developed in 2 cases that received a larger volume of injectate than the other cases. Thus, we are suggesting that the volume of injectate may be a contributing factor for acute paraplegia after lumbar steroid injection in patients with SDAVFs. PMID:27847727

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

    PubMed Central

    2014-01-01

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

  7. Dynamic lumbar spinal stenosis : the usefulness of axial loaded MRI in preoperative evaluation.

    PubMed

    Choi, Kyung-Chul; Kim, Jin-Sung; Jung, Byungjoo; Lee, Sang-Ho

    2009-09-01

    Two cases of dynamic lumbar spinal stenosis were identified by the authors using axial loaded magnetic resonance image (MRI). In both cases, the patients presented with neurogenic claudication but MRI in decumbency showed no definite pathologic condition associated with their symptoms. In contrast, axial loaded MRI demonstrated constrictive spinal stenosis and a significantly decreased dural sac caused by epidural fat buckling and thickening of the ligamentum flavum in both cases. In the second case, a more prominent disc protrusion was also demonstrated compared with decumbent MRI. After decompressive surgery, both patients had satisfactory outcomes. Axial loaded MRI can therefore give decisive information in dynamic spinal disorders by allowing simulation of an upright position.

  8. A New Acute Impact-Compression Lumbar Spinal Cord Injury Model in the Rodent

    PubMed Central

    Moonen, Gray; Satkunendrarajah, Kajana; Wilcox, Jared T.; Badner, Anna; Mothe, Andrea; Foltz, Warren; Fehlings, Michael G.

    2016-01-01

    Abstract Traumatic injury to the lumbar spinal cord results in complex central and peripheral nervous tissue damage causing significant neurobehavioral deficits and personal/social adversity. Although lumbar cord injuries are common in humans, there are few clinically relevant models of lumbar spinal cord injury (SCI). This article describes a novel lumbar SCI model in the rat. The effects of moderate (20 g), moderate-to-severe (26 g) and severe (35 g, and 56 g) clip impact-compression injuries at the lumbar spinal cord level L1-L2 (vertebral level T11-T12) were assessed using several neurobehavioral, neuroanatomical, and electrophysiological outcome measures. Lesions were generated after meticulous anatomical landmarking using microCT, followed by laminectomy and extradural inclusion of central and radicular elements to generate a traumatic SCI. Clinically relevant outcomes, such as MR and ultrasound imaging, were paired with robust morphometry. Analysis of the lesional tissue demonstrated that pronounced tissue loss and cavitation occur throughout the acute to chronic phases of injury. Behavioral testing revealed significant deficits in locomotion, with no evidence of hindlimb weight-bearing or hindlimb-forelimb coordination in any injured group. Evaluation of sensory outcomes revealed highly pathological alterations including mechanical allodynia and thermal hyperalgesia indicated by increasing avoidance responses and decreasing latency in the tail-flick test. Deficits in spinal tracts were confirmed by electrophysiology showing increased latency and decreased amplitude of both sensory and motor evoked potentials (SEP/MEP), and increased plantar H-reflex indicating an increase in motor neuron excitability. This is a comprehensive lumbar SCI model and should be useful for evaluation of translationally oriented pre-clinical therapies. PMID:26414192

  9. Patterns of chronic adhesive arachnoiditis following Myodil myelography: the significance of spinal canal stenosis and previous surgery.

    PubMed

    Laitt, R; Jackson, A; Isherwood, I

    1996-08-01

    109 patients who had undergone Myodil myelography on at least one occasion were identified. The patterns of lumbar nerve root distribution in this group were examined using magnetic resonance imaging. The relationship between these patterns and the presence of spinal stenosis or previous surgery was investigated. Chronic adhesive arachnoiditic nerve root patterns were seen in 68 patients and were classified into three groups according to Delemarter et al. Central clumping of nerve roots (type 1) and complete opacification of the thecal sac (type 3), extending over at least one vertebral level, were significantly related to spinal stenosis at an adjacent level (p < 0.0001). Peripheral adhesion of nerve roots to the theca (type 2) was significantly related to previous surgery at the level of abnormality (p < 0.00005). Only a single case of arachnoiditic nerve root patterns was seen in the absence of stenosis or previous surgery. We conclude that chronic adhesive arachnoiditis is significantly related to previous Myodil myelography in the presence of spinal stenosis or previous surgery but that Myodil alone rarely produces these changes.

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

    PubMed

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

    2010-11-01

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

  11. Thoracic paraplegia due to missed thoracic compressive lesions after lumbar spinal decompression surgery. Report of three cases.

    PubMed

    Takeuchi, Akihiko; Miyamoto, Kei; Hosoe, Hideo; Shimizu, Katsuji

    2004-01-01

    The authors discuss the cases of three patients in whom thoracic paraplegia developed after lumbar spinal decompressive surgery for slight lumbar spinal canal stenosis. Careful computerized tomography myelography and magnetic resonance imaging examination of the thoracic spine revealed another compressive lesion (spinal cord tumor, disc herniation, osteophyte of vertebral body, and ossification of the ligamentum flavum). Additional thoracic decompressive surgery provided partial amelioration of each patient's neurological condition. The authors suggest that to avoid such a complication physical and radiographic examination of the thoracic spine should be performed preoperatively if the lumbar imaging is inconclusive.

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

    PubMed

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

    2012-05-30

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

  13. Quantification of cavitation and gapping of lumbar zygapophyseal joints during spinal manipulative therapy.

    PubMed

    Cramer, Gregory D; Ross, Kim; Raju, P K; Cambron, Jerrilyn; Cantu, Joe A; Bora, Preetam; Dexheimer, Jennifer M; McKinnis, Ray; Habeck, Adam R; Selby, Scott; Pocius, Judith D; Gregerson, Douglas

    2012-10-01

    The purpose of this study was to use previously validated methods to quantify and relate 2 phenomena associated with chiropractic spinal manipulative therapy (SMT): (1) cavitation and (2) the simultaneous gapping (separation) of the lumbar zygapophyseal (Z) joint spaces. This was a randomized, controlled, mechanistic clinical trial with blinding. Forty healthy participants (18-30 years old) without a history of low-back pain participated. Seven accelerometers were affixed to the skin overlying the spinous processes of L1 to L5 and the S1 and S2 sacral tubercles. Two additional accelerometers were positioned 3 cm left and right lateral to the L4/L5 interspinous space. Participants were randomized into group 1, side-posture SMT (n = 30), or group 2, side-posture positioning (SPP, n = 10). Cavitations were determined by accelerometer recordings during SMT and SPP (left side = upside for both groups); gapping (gapping difference) was determined by the difference between pre- and postintervention magnetic resonance imaging scan joint space measurements. Results of mean gapping differences were compared. Upside SMT and SPP joints gapped more than downside joints (0.69 vs -0.17 mm, P < .0001). Spinal manipulative therapy upside joints gapped more than SPP upside joints (0.75 vs 0.52 mm, P = .03). Spinal manipulative therapy upside joints gapped more in men than in women (1.01 vs 0.49 mm, P < .002). Overall, joints that cavitated gapped more than those that did not (0.56 vs 0.22 mm, P = .01). No relationship was found between the occurrence of cavitation and gapping with upside joints alone (P = .43). Zygapophyseal joints receiving chiropractic SMT gapped more than those receiving SPP alone; Z joints of men gapped more than those of women, and cavitation indicated that a joint had gapped but not how much a joint had gapped. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

  14. Large spinal meningioma with hemorrhage after selective root block in the thoraco-lumbar spine.

    PubMed

    Lee, Heui Seung; Lee, Sang Hyung; Chung, Young Seob; Yang, Hee-Jin; Son, Young-Je; Park, Sung Bae

    2013-12-01

    Spinal meningioma accounts for 25% of all spinal cord tumors and occurs mostly in the thoracic region. Spontaneous intraspinal bleeding associated with spinal meningioma has rarely been reported. Most cases of hemorrhage associated with meningiomas are extratumoral and subarachnoid, whereas subdural and intratumoral hemorrhage cases have been reported to occur rarely. We experienced a case of a 58-year-old woman with thoracolumbar spinal meningioma accompanied by intraspinal subdural hematoma. She presented with progressively worsened back pain and newly developed weakness in the right lower extremity after a selective nerve root block in the lumbar spine. She underwent the operation and progressively showed neurological recovery during the postoperative course. We report a thoracolumbarspinal meningioma with subdural and intratumoral hemorrhage after a spinal procedure that caused a sudden neurological deterioration.

  15. Large Spinal Meningioma with Hemorrhage after Selective Root Block in the Thoraco-Lumbar Spine

    PubMed Central

    Lee, Heui Seung; Lee, Sang Hyung; Chung, Young Seob; Yang, Hee-Jin; Son, Young-Je

    2013-01-01

    Spinal meningioma accounts for 25% of all spinal cord tumors and occurs mostly in the thoracic region. Spontaneous intraspinal bleeding associated with spinal meningioma has rarely been reported. Most cases of hemorrhage associated with meningiomas are extratumoral and subarachnoid, whereas subdural and intratumoral hemorrhage cases have been reported to occur rarely. We experienced a case of a 58-year-old woman with thoracolumbar spinal meningioma accompanied by intraspinal subdural hematoma. She presented with progressively worsened back pain and newly developed weakness in the right lower extremity after a selective nerve root block in the lumbar spine. She underwent the operation and progressively showed neurological recovery during the postoperative course. We report a thoracolumbarspinal meningioma with subdural and intratumoral hemorrhage after a spinal procedure that caused a sudden neurological deterioration. PMID:24891860

  16. Mini-Open Anterior Lumbar Interbody Fusion Combined with Lateral Lumbar Interbody Fusion in Corrective Surgery for Adult Spinal Deformity

    PubMed Central

    Lee, Chong-Suh; Chung, Sung-Soo; Lee, Jun-Young; Yum, Tae-Hoon; Shin, Seong-Kee

    2016-01-01

    Study Design Prospective observational study. Purpose To introduce the techniques and present the surgical outcomes of mini-open anterior lumbar interbody fusion (ALIF) at the most caudal segments of the spine combined with lateral lumbar interbody fusion (LLIF) for the correction of adult spinal deformity Overview of Literature Although LLIF is increasingly used to correct adult spinal deformity, the correction of sagittal plane deformity with LLIF alone is reportedly suboptimal. Methods Thirty-two consecutive patients with adult spinal deformity underwent LLIF combined with mini-open ALIF at the L5–S1 or L4–S1 levels followed by 2-stage posterior fixation. ALIF was performed for a mean 1.3 levels and LLIF for a mean 2.7 levels. Then, percutaneous fixation was performed in 11 patients (percutaneous group), open correction with facetectomy with or without laminectomy in 16 (open group), and additional pedicle subtraction osteotomy (PSO) in 5 (PSO group). Spinopelvic parameters were compared preoperatively and postoperatively. Hospitalization data and clinical outcomes were recorded. Results No major medical complications developed, and clinical outcomes improved postoperatively in all groups. The mean postoperative segmental lordosis was greater after ALIF (17.5°±5.5°) than after LLIF (8.1°±5.3°, p <0.001). Four patients (12.5%) had lumbar lordosis with a pelvic incidence of ±9° preoperatively, whereas this outcome was achieved postoperatively in 30 patients (93.8%). The total increase in lumbar lordosis was 14.7° in the percutaneous group, 35.3° in the open group, and 57.0° in the PSO group. The ranges of potential lumbar lordosis increase were estimated as 4°–25°, 23°–42°, and 45°–65°, respectively. Conclusions Mini-open ALIF combined with LLIF followed by posterior fixation may be a feasible technique for achieving optimal sagittal balance and reducing the necessity of more extensive surgery. PMID:27994777

  17. Afferent inputs to mid- and lower-lumbar spinal segments are necessary for stepping in spinal cats

    PubMed Central

    Norton, Jonathan A.; Mushahwar, Vivian K.

    2010-01-01

    Afferent inputs are known to modulate the activity of locomotor central pattern generators, but their role in the generation of locomotor patterns remains uncertain. This study sought to investigate the importance of afferent input for producing bilateral, coordinated hindlimb stepping in adult cats. Following complete spinal transection, animals were trained to step on the moving belt of a treadmill until proficient, weight-bearing stepping of the hindlimbs was established. Selective dorsal rhizotomies of roots reaching various segments of the lumbosacral enlargement were then conducted, and hindlimb stepping capacity was reassessed. Depending on the deafferented lumbosacral segments, stepping was either abolished or unaffected. Deafferentation of mid-lumbar (L3/L4) or lower-lumbar (L5-S1) segments abolished locomotion. Locomotor capacity in these animals could not be restored with the administration of serotonergic or adrenergic agonists. Deafferentation of L3, L6, or S1 had mild effects on locomotion. This suggested that critical afferent inputs pertaining to hip position (mid-lumbar) and limb loading (lower-lumbar) play an important role in the generation of locomotor patterns after spinal cord injury. PMID:20536916

  18. The effect of inter-electrode distance on the electric field distribution during transcutaneous lumbar spinal cord direct current stimulation.

    PubMed

    Bastos, Rui; Fernandes, Sofia R; Salvador, Ricardo; Wenger, Cornelia; de Carvalho, Mamede A; Miranda, Pedro C; Bastos, Rui; Fernandes, Sofia R; Salvador, Ricardo; Wenger, Cornelia; de Carvalho, Mamede A; Miranda, Pedro C; Miranda, Pedro C; Bastos, Rui; Wenger, Cornelia; Salvador, Ricardo; de Carvalho, Mamede A; Fernandes, Sofia R

    2016-08-01

    Previous studies have indicated potential neuromodulation of the spinal circuitry by transcutaneous spinal direct current stimulation (tsDCS), such as changes in motor unit recruitment, shortening of the peripheral silent period and interference with supraspinal input to lower motor neurons. All of these effects were dependent on the polarity of the electrodes. The present study investigates how the distance between the electrodes during tsDCS influences the electric field's (E-field) spatial distribution in the lumbar and sacral spinal cord (SC). The electrodes were placed longitudinally along the SC, with the target electrode over the lumbar spine, and the return electrode above the former, considering four different distances (4, 8, 12 and 16 cm from the target). A fifth configuration was also tested with the return electrode over the right deltoid muscle. Peak values of the E-field's magnitude are found in the lumbo-sacral region of the SC for all tested configurations. Increasing the distance between the electrodes results in a wider spread of the E-field magnitude distribution along the SC, with larger maximum peak values and a smoother variation. The fifth configuration does not present the highest maximum values when compared to the other configurations. The results indicate that the choice of the return electrode position relative to the target can influence the distribution and the range of values of the E-field magnitude in the SC. Possible clinical significance of the observed effects will be discussed.

  19. Spinal Posture of Thoracic and Lumbar Spine and Pelvic Tilt in Highly Trained Cyclists

    PubMed Central

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

    2011-01-01

    The aim of this study was to evaluate sagittal thoracic and lumbar spinal curvatures and pelvic tilt in elite and master cyclists when standing on the floor, and sitting on a bicycle at three different handlebar-hand positions. A total of 60 elite male cyclists (mean age: 22.95 ± 3.38 years) and 60 master male cyclists (mean age: 34.27 ± 3.05 years) were evaluated. The Spinal Mouse system was used to measure sagittal thoracic and lumbar curvature in standing on the floor and sitting positions on the bicycle at three different handlebar-hand positions (high, medium, and low). The mean values for thoracic and lumbar curvatures and pelvic tilt in the standing position on the floor were 48.17 ± 8.05°, -27.32 ± 7.23°, and 13.65 ± 5.54°, respectively, for elite cyclists and 47.02 ± 9.24°, -25.30 ± 6.29°, and 11.25 ± 5.17° for master cyclists. A high frequency of thoracic hyperkyphosis in the standing position was observed (58.3% in elite cyclists and 53.3% in master cyclists), whereas predominately neutral values were found in the lumbar spine (88.3% and 76.7% in elite and master cyclists, respectively). When sitting on the bicycle, the thoracic curve was at a lower angle in the three handlebar-hand positions with respect to the standing position on the floor in both groups (p < 0.01). The lumbar curve adopted a kyphotic posture. In conclusion, cyclists present a high percentage of thoracic hyperkyphotic postures in standing positions on the floor. However, thoracic hyperkyphosis is not directly related to positions adopted on the bicycle. Key points This study evaluated thoracic and lumbar spinal curvatures and pelvic tilt in elite and master cyclists while standing and sitting on the bicycle. Elite and master cyclists showed a high frequency of thoracic hyperkyphosis and neutral lumbar lordosis in standing. Cyclists adopted a significantly lower thoracic kyphosis on the bicycle at the three handlebar positions analysed (upper, middle and lower handlebars

  20. Comparison of Treatment Methods in Lumbar Spinal Stenosis for Geriatric Patient: Nerve Block Versus Radiofrequency Neurotomy Versus Spinal Surgery

    PubMed Central

    Park, Chang Kyu; Kim, Min Ki; Park, Bong Jin; Choi, Seok Geun; Lim, Young Jin; Kim, Tae Sung

    2014-01-01

    Objective The incidence of spinal treatment, including nerve block, radiofrequency neurotomy, instrumented fusions, is increasing, and progressively involves patients of age 65 and older. Treatment of the geriatric patients is often a difficult challenge for the spine surgeon. General health, sociofamilial and mental condition of the patients as well as the treatment techniques and postoperative management are to be accurately evaluated and planned. We tried to compare three treatment methods of spinal stenosis for geriatric patient in single institution. Methods The cases of treatment methods in spinal stenosis over than 65 years old were analyzed. The numbers of patients were 371 underwent nerve block, radiofrequency neurotomy, instrumented fusions from January 2009 to December 2012 (nerve block: 253, radiofrequency neurotomy: 56, instrumented fusions: 62). The authors reviewed medical records, operative findings and postoperative clinical results, retrospectively. Simple X-ray were evaluated and clinical outcome was measured by Odom's criteria at 1 month after procedures. Results We were observed excellent and good results in 162 (64%) patients with nerve block, 40 (71%) patient with radIofrequency neurotomy, 46 (74%) patient with spinal surgery. Poor results were 20 (8%) patients in nerve block, 2 (3%) patients in radiofrequency neurotomy, 3 (5%) patient in spinal surgery. Conclusion We reviewed literatures and analyzed three treatment methods of spinal stenosis for geriatric patients. Although the long term outcome of surgical treatment was most favorable, radiofrequency neurotomy and nerve block can be considered for the secondary management of elderly lumbar spinals stenosis patients. PMID:25346752

  1. Comparison of treatment methods in lumbar spinal stenosis for geriatric patient: nerve block versus radiofrequency neurotomy versus spinal surgery.

    PubMed

    Park, Chang Kyu; Kim, Sung Bum; Kim, Min Ki; Park, Bong Jin; Choi, Seok Geun; Lim, Young Jin; Kim, Tae Sung

    2014-09-01

    The incidence of spinal treatment, including nerve block, radiofrequency neurotomy, instrumented fusions, is increasing, and progressively involves patients of age 65 and older. Treatment of the geriatric patients is often a difficult challenge for the spine surgeon. General health, sociofamilial and mental condition of the patients as well as the treatment techniques and postoperative management are to be accurately evaluated and planned. We tried to compare three treatment methods of spinal stenosis for geriatric patient in single institution. The cases of treatment methods in spinal stenosis over than 65 years old were analyzed. The numbers of patients were 371 underwent nerve block, radiofrequency neurotomy, instrumented fusions from January 2009 to December 2012 (nerve block: 253, radiofrequency neurotomy: 56, instrumented fusions: 62). The authors reviewed medical records, operative findings and postoperative clinical results, retrospectively. Simple X-ray were evaluated and clinical outcome was measured by Odom's criteria at 1 month after procedures. We were observed excellent and good results in 162 (64%) patients with nerve block, 40 (71%) patient with radIofrequency neurotomy, 46 (74%) patient with spinal surgery. Poor results were 20 (8%) patients in nerve block, 2 (3%) patients in radiofrequency neurotomy, 3 (5%) patient in spinal surgery. We reviewed literatures and analyzed three treatment methods of spinal stenosis for geriatric patients. Although the long term outcome of surgical treatment was most favorable, radiofrequency neurotomy and nerve block can be considered for the secondary management of elderly lumbar spinals stenosis patients.

  2. Difficulty of diagnosing the origin of lower leg pain in patients with both lumbar spinal stenosis and hip joint osteoarthritis.

    PubMed

    Saito, Junya; Ohtori, Seiji; Kishida, Shunji; Nakamura, Junichi; Takeshita, Munenori; Shigemura, Tomonori; Takazawa, Makoto; Eguchi, Yawara; Inoue, Gen; Orita, Sumihisa; Takaso, Masashi; Ochiai, Nobuyasu; Kuniyoshi, Kazuki; Aoki, Yasuchika; Ishikawa, Tetsuhiro; Arai, Gen; Miyagi, Masayuki; Kamoda, Hiroto; Suzuki, Miyako; Sakuma, Yoshihiro; Oikawa, Yasuhiro; Kubota, Gou; Inage, Kazuhide; Sainoh, Takeshi; Yamauchi, Kazuyo; Toyone, Tomoaki; Takahashi, Kazuhisa

    2012-12-01

    Case series. To present the difficulty of diagnosing the origin of lower leg pain in patients with lumbar spinal stenosis and hip joint arthritis. Pain arising from a degenerated hip joint is sometimes localized to the lower leg. Patients with lumbar spinal disease may also show radicular pain corresponding to the lower leg area. If patients present with both conditions and only pain at the lower leg, it is difficult to determine the origin of the pain. We reviewed 420 patients who had leg pain with lumbar spinal stenosis diagnosed by myelography, computed tomography after myelography, or magnetic resonance imaging. Pain only at the ipsilateral lateral aspect of the lower leg but slight low back pain or pain around the hip joint was shown in 4 patients who had lumbar spinal stenosis and hip osteoarthritis. The symptoms resolved after L5 spinal nerve block, but remained after lidocaine infiltration into the hip joint. We performed decompression and posterolateral fusion surgery for these 4 patients. Leg pain did not resolve after lumbar surgery in all patients. Conservative treatment was not effective from 6 to 12 months, so ultimately we performed ipsilateral total hip replacement for all patients and they became symptom-free. It is difficult to determine the origin of lower leg pain by spinal nerve block and hip joint block in patients with lumbar spinal stenosis and hip osteoarthritis. We take this into consideration before surgery.

  3. Granular cell tumor in a lumbar spinal nerve of a dog.

    PubMed

    Rao, Deepa; Rylander, Helena; Drees, Randi; Schwarz, Tobias; Steinberg, Howard

    2010-07-01

    A 2-year-old Great Dane dog with a 2.5-week history of progressive paraparesis was presented to the Veterinary Medical Teaching Hospital at the University of Wisconsin-Madison. Neurologic examination revealed nonambulatory paraparesis with reduced to absent withdrawal hind-limb reflexes and lumbar pain. Magnetic resonance imaging and gross pathology confirmed a larger regional lumbar mass and a second smaller extradural mass within the spinal canal. The left lumbar mass was associated with extensive hemorrhage; dissection showed a dark-red, soft, well-circumscribed mass measuring 2 cm x 1.5 cm x 0.5 cm within the left fourth lumbar spinal nerve. Histopathological evaluation with immunohistochemistry revealed sheets of round to polygonal cells with diffuse granular cytoplasm demonstrating diastase-resistant periodic acid-Schiff reactivity and positive immunoexpression of S100 and neuron-specific enolase. The smaller extradural mass within the spinal canal exhibited similar morphology. Based on gross, histological, and immunohistochemical evidence, the masses were diagnosed as granular cell tumor.

  4. Spinal muscles can create compressive follower loads in the lumbar spine in a neutral standing posture.

    PubMed

    Han, Kap-Soo; Rohlmann, Antonius; Yang, Seok-Jo; Kim, Byeong Sam; Lim, Tae-Hong

    2011-05-01

    The ligamentous spinal column buckles under compressive loads of even less than 100N. Experimental results showed that under the follower load constraint, the ligamentous lumbar spine can sustain large compressive loads without buckling, while at the same time maintaining its flexibility reasonably well. The purpose of this study was to investigate the feasibility of follower loads produced by spinal muscles in the lumbar spine in a quiet standing posture. A three-dimensional static model of the lumbar spine incorporating 232 back muscles was developed and utilized to perform the optimization analysis in order to find the muscle forces, and compressive follower loads (CFLs) along optimum follower load paths (FLPs). The effect of increasing external loads on CFLs was also investigated. An optimum solution was found which is feasible for muscle forces producing minimum CFLs along the FLP located 11 mm posterior to the curve connecting the geometrical centers of the vertebral bodies. Activation of 30 muscles was found to create CFLs with zero joint moments in all intervertebral joints. CFLs increased with increasing external loads including FLP deviations from the optimum location. Our results demonstrate that spinal muscles can create CFLs in the lumbar spine in a neutral standing posture in vivo to sustain stability. Therefore, its application in experimental and numerical studies concerning loading conditions seems to be suitable for the attainment of realistic results. Published by Elsevier Ltd.

  5. The pathologic mechanisms underlying lumbar distraction spinal cord injury in rabbits.

    PubMed

    Wu, Di; Zheng, Chao; Wu, Ji; Xue, Jing; Huang, Rongrong; Wu, Di; Song, Yueming

    2017-06-27

    A reliable experimental rabbit model of distraction spinal cord injury (SCI) was established to successfully simulate gradable and replicable distraction SCI. However, further research is needed to elucidate the pathologic mechanisms underlying distraction SCI. The aim of this study was to investigate the pathologic mechanisms underlying lumbar distraction SCI in rabbits. This is an animal laboratory study. Using a self-designed spine distractor, the experimental animals were divided into a control group and 10%, 20%, and 30% distraction groups. Pathologic changes to the spinal cord microvessels in the early stage of distraction SCI were identified by perfusion of the spinal cord vasculature with ink, production of transparent specimens, observation by light microscopy, and observation of corrosion casts of the spinal cord microvascular architecture by scanning electron microscopy. Malondialdehyde (MDA) and superoxide dismutase (SOD) concentrations in the injured spinal cord tissue were measured after 8 hours. With an increasing degree and duration of distraction, the spinal cord microvessels were only partially filled and had the appearance of spasm until rupture and hemorrhage were observed. The MDA concentration increased and the SOD concentration decreased in the spinal cord tissue. Changes to the internal and external spinal cord vessels led to spinal cord ischemia, which is a primary pathologic mechanism of distraction SCI. Lipid peroxidation mediated by free radicals took part in secondary pathologic damage of distraction SCI. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    PubMed

    Zhang, Yanxin; Ma, Ye; Liu, Guangyu

    2016-01-01

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

  7. The Use of Closed Suction Drainage in Lumbar Spinal Surgery: Is It Really Necessary?

    PubMed

    Liu, Jia-Ming; Chen, Wen-Zhao; Fu, Bi-Qi; Chen, Jiang-Wei; Liu, Zhi-Li; Huang, Shan-Hu

    2016-06-01

    Closed wound suction drainage after spine surgery is commonly used in clinical practice. However, no consensus has been reached for using drainage versus nondrainage after lumbar spinal surgery until now. The purpose of this study was to determine the clinical outcomes of using closed suction drainage versus nondrainage after lumbar spinal surgery. We conducted a systematic review and meta-analysis to identify relevant studies from PubMed, MEDLINE, EMBASE, Cochrane Library, and Google scholar up to September 2015. All randomized, quasi-randomized, and controlled clinical studies, which compared the clinical outcomes of using closed suction drainage versus nondrainage in patients who underwent lumbar spinal surgery, were included. Data extraction and quality assessment were according to Cochrane Collaboration guidelines. Five studies involving 1295 patients were included in this meta-analysis. By pooling the clinical outcomes, there were no significant differences between patients with drainage and nondrainage in terms of the incidence of wound infection (odds ratio [OR], 1.48; 95% confidence interval [CI], 0.47-4.71; P = 0.50), wound hematoma (OR, 0.45; 95% CI, 0.01-29.31, P = 0.71), and reoperation (OR, 1.36; 95% CI, 0.22-8.27; P = 0.74). Drainage after lumbar surgery was associated with more blood loss and significantly greater blood transfusions (OR, 3.68; 95% CI, 1.80-7.54; P < 0.01) compared with nondrainage. However, more patients contracted postoperative fever in the nondrainage group than did those in drainage group. Based on this systematic review and meta-analysis, there is insufficient evidence to suggest routine use of prophylactic closed suction drainage after lumbar spinal surgery. However, a decision to use or not use drainage should be individualized for each patient because many factors affect the outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation in surgical treatment for single-segment lumbar spinal tuberculosis.

    PubMed

    Zeng, Hao; Wang, Xiyang; Zhang, Penghui; Peng, Wei; Liu, Zheng; Zhang, Yupeng

    2015-01-01

    The aim of this study is to determine the feasibility and efficacy of surgical management of single-segment lumbar spinal tuberculosis (TB) by using single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation. Seventeen cases of single-segment lumbar TB were treated with single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation. The mean follow-up was 36.9 months (range: 24-62 months). The kyphotic angle ranged from 15.2-35.1° preoperatively, with an average measurement of 27.8°. The American Spinal Injury Association (ASIA) score system was used to evaluate the neurological deficits and erythrocyte sedimentation rate (ESR) used to judge the activity of TB. Spinal TB was completely cured in all 17 patients. There was no recurrent TB infection. The postoperative kyphotic angle was 6.6-10.2°, 8.1° in average, and there was no significant loss of the correction at final follow-up. Solid fusion was achieved in all cases. Neurological condition in all patients was improved after surgery. Single-stage posterior transforaminal lumbar interbody fusion, debridement, limited decompression, 3-column reconstruction, and posterior instrumentation can be a feasible and effective method the in treatment of single-segment lumbar spinal TB.

  9. [Panlongqi tablet (Chinese characters) combined with lumbar facet joint release for the treatment of lumbar spinal stenosis of Fengshi Bizu (Chinese characters)].

    PubMed

    Deng, Xiao-chuan; Yang, Ao-fei; He, Cheng-jian

    2014-10-01

    To investigate the clinical efficacy of Panlongqi tablet (Chinese characters) combined with lumbar facet joint release for lumbar spinal stenosis of type Fengshi Bizu (Chinese characters). Since February 2012 to February 2013, 120 patients with lumbar spinal stenosis of Fengshi Bizu (Chinese characters) syndrome were retrospectively studied. According to different treatment methods, 120 patients with lumbar spinal stenosis were divided into Panlongqi tablet (Chinese characters)group and control groups, respectively. In Panlongqi tablet (Chinese characters)group, 60 patients were treated by Panlongqi tablet (Chinese characters) combined with lumbar facet joints release solution including 26 males and 34 females with an average age of (60.40±3.36) years old ranging from 46 to 65 ; the course of the disease was 2 to 15 years (averaged 7.6 years). In control group the other 60 patients were treated with lumbar facet joint release including 24 males and 36 females with an average age of (61.20±2.47) years old ranging from 48 to 63; the course was 3 to 14 years (averaged 6.9 years). The clinical effect of patients were evaluated by JOA and ODI score before treatment, at 4 weeks and 3 months after treatment. All patients were followed up for 4 to 7 months (means 5.6 months). After 3 months,7 cases in control group recurrenced symptoms,only 1 case in Panlongqi tablet (Chinese characters) group recurrenced. At 4 weeks and 3 months of follow-up, ODI score and JOA score of Panlongqi tablet group were much better than those of the control group. For lumbar spinal stenosis of type Fengshi Bizu (Chinese characters),which were treated with lumbar facet joint release with Panlongqi tablet(Chinese characters), supplemented by back muscle exercise, in relieving waist and low back pain symptoms and improving functional status of lower lumbar spine, can obtain satisfactory clinical outcome, is a good method of conservative treatment for such diseases.

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

    Makirov, Serik K; Yuz, Andrew A; Jahaf, Mohammed T; Nikulina, Anastasia A

    2015-01-01

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

  12. Prevalence, Spinal Alignment, and Mobility of Lumbar Spinal Stenosis with or without Chronic Low Back Pain: A Community-Dwelling Study

    PubMed Central

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

    2011-01-01

    Although lumbar spinal stenosis (LSS) occurs almost universally with aging, little is known regarding its actual prevalence and relationships to chronic low back pain (CLBP) in the general population. The presence of CLBP in subjects with LSS may have negative impacts on spinal alignment and mobility. This study evaluated the prevalence of LSS using a self-administered, self-reported history questionnaire in 630 community-dwelling individuals ≥50 years old. Subjects with LSS were further divided into LSS+CLBP and LSS alone groups, and spinal alignment and mobility were compared using a computer-assisted device. Prevalence of LSS was 10.8% in this cohort. Subjects in the LSS+CLBP group (n = 46) showed a significantly more kyphotic lumbar spinal alignment with limited lumbar extension (P < .05), resulting in a stooped trunk compared to subjects in the LSS alone group (n = 22). However, no significant difference in spinal mobility was seen between groups. PMID:22110922

  13. Spinal epidural arteriovenous hemangioma mimicking lumbar disc herniation.

    PubMed

    Kim, Kyung Hyun; Song, Sang Woo; Lee, Soo Eon; Lee, Sang Hyung

    2012-10-01

    A spinal epidural hemangioma is rare. In this case, a 51 year-old female patient had low back pain and right thigh numbness. She was initially misdiagnosed as having a ruptured disc with possible sequestration of granulation tissue formation due to the limited number of spinal epidural hemangiomas and little-known radiological findings. Because there are no effective diagnostic tools to verify the hemangioma, more effort should be put into preoperative imaging tests to avoid misdiagnosis and poor decisions).

  14. The Multiple Benefits of Minimally Invasive Spinal Surgery: Results Comparing Transforaminal Lumbar Interbody Fusion and Posterior Lumbar Fusion

    PubMed Central

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

    2013-01-01

    Minimally invasive transforaminal lumbar interbody fusion (TLIF) offers equivalent postoperative fusion rates compared to posterior lumbar fusion (PLF) and minimizes the amount of iatrogenic injury to the spinal muscles. The objective of this study was to examine the difference in pain perception, stress, mood disturbance, quality of life, and immunological indices throughout the perioperative course among patients undergoing TLIF and PLF. A prospective, nonrandomized descriptive design was used to evaluate these measures among patients undergoing TLIF (n = 17) or PLF (n = 18) at 1 week prior to surgery (T1), the day of surgery (T2), 24 hours postoperatively (T3), and 6 weeks postoperatively (T4). Among TLIF patients, pain, stress, fatigue, and mood disturbance were significantly decreased at the 6-week follow-up visit (T4) compared to patients who underwent PLF. The TLIF group also demonstrated significantly higher levels (near baseline) of CD8 cells atT4 than the PLF group. Interleukin-6 levels were significantly higher in the TLIF group as well, which may be an indicator of ongoing nerve regeneration and healing. Knowledge concerning the effect of pain and the psychological experience on immunity among individuals undergoing spinal fusion can help nurses tailor interventions to improve outcomes, regardless of the approach used. PMID:18330408

  15. Factors associated with improvement in sagittal spinal alignment after microendoscopic laminotomy in patients with lumbar spinal canal stenosis.

    PubMed

    Dohzono, Sho; Toyoda, Hiromitsu; Takahashi, Shinji; Matsumoto, Tomiya; Suzuki, Akinobu; Terai, Hidetomi; Nakamura, Hiroaki

    2016-07-01

    OBJECTIVE Little is known about the relationship between sagittal spinal alignment in patients with lumbar spinal canal stenosis (LSS) and objective findings such as spinopelvic parameters, lumbar back muscle degeneration, and clinical data. The purpose of this study was to identify the preoperative clinical and radiological factors that predict improvement in sagittal spinal alignment after decompressive surgery in patients with LSS. METHODS The records of 61 patients with LSS who underwent microendoscopic laminotomy and had pre- and postoperative clinical data collected were retrospectively reviewed. Spinopelvic parameters, including sagittal vertical axis (SVA), lumbar lordosis (LL), sacral slope, pelvic tilt, and pelvic incidence (PI), were evaluated. On T2-weighted MRI, the cross-sectional area and the percentage of fat infiltration of the paravertebral muscles (PVMs) before surgery were calculated. For patients with preoperative SVA > 40 mm (n = 30), the correlation between SVA improvement and preoperative clinical and radiographic parameters was calculated. RESULTS SVA improvement correlated with preoperative LL (r = -0.39) and PI -LL (r = 0.54). Multiple regression analysis showed that preoperative PI -LL (beta = 0.62; p < 0.01) and symptom duration (beta = -0.40; p < 0.05) were independently associated with SVA improvement. The percentage of fat infiltration of the PVM at L4-5 was significantly greater in patients with preoperative SVA ≥ 40 mm than in those patients with SVA < 40 mm. CONCLUSIONS Preoperative PI -LL and symptom duration were independently associated with SVA improvement in LSS patients with forward-bending posture. PVM degeneration at the lower lumbar level was significantly greater among patients with preoperative SVA ≥ 40 mm than in patients with SVA < 40 mm.

  16. Pelvic incidence-lumbar lordosis mismatch predisposes to adjacent segment disease after lumbar spinal fusion.

    PubMed

    Rothenfluh, Dominique A; Mueller, Daniel A; Rothenfluh, Esin; Min, Kan

    2015-06-01

    Several risk factors and causes of adjacent segment disease have been debated; however, no quantitative relationship to spino-pelvic parameters has been established so far. A retrospective case-control study was carried out to investigate spino-pelvic alignment in patients with adjacent segment disease compared to a control group. 45 patients (ASDis) were identified that underwent revision surgery for adjacent segment disease after on average 49 months (7-125), 39 patients were selected as control group (CTRL) similar in the distribution of the matching variables, such as age, gender, preoperative degenerative changes, and numbers of segments fused with a mean follow-up of 84 months (61-142) (total n = 84). Several radiographic parameters were measured on pre- and postoperative radiographs, including lumbar lordosis measured (LL), sacral slope, pelvic incidence (PI), and tilt. Significant differences between ASDis and CTRL groups on preoperative radiographs were seen for PI (60.9 ± 10.0° vs. 51.7 ± 10.4°, p = 0.001) and LL (48.1 ± 12.5° vs. 53.8 ± 10.8°, p = 0.012). Pelvic incidence was put into relation to lumbar lordosis by calculating the difference between pelvic incidence and lumbar lordosis (∆PILL = PI-LL, ASDis 12.5 ± 16.7° vs. CTRL 3.4 ± 12.1°, p = 0.001). A cutoff value of 9.8° was determined by logistic regression and ROC analysis and patients classified into a type A (∆PILL <10°) and a type B (∆PILL ≥10°) alignment according to pelvic incidence-lumbar lordosis mismatch. In type A spino-pelvic alignment, 25.5 % of patients underwent revision surgery for adjacent segment disease, whereas 78.3 % of patients classified as type B alignment had revision surgery. Classification of patients into type A and B alignments yields a sensitivity for predicting adjacent segment disease of 71 %, a specificity of 81 % and an odds ratio of 10.6. In degenerative disease of the lumbar spine a high pelvic incidence with diminished lumbar lordosis seems

  17. Plastic changes in lumbar segments after thoracic spinal cord injuries in adult rats: an integrative view of spinal nociceptive dysfunctions.

    PubMed

    Redondo-Castro, Elena; García-Alías, Guillermo; Navarro, Xavier

    2013-01-01

    Spinal cord injuries (SCI) cause motor, sensory and autonomic dysfunctions as well as neuropathic pain. We investigated plastic changes occurring in cord segments caudal to the lesion to assess their potential contribution to pain states after SCI. Different thoracic SCIs were performed in adult rats. Functional and algesimetry tests were performed along 3 months. Several elements of the spinal nociceptive circuitry were assessed by immunohistochemical analyses of lumbar segments. Injured animals manifested mechanical and thermal hyperalgesia. Wind-up responses and spinal reflexes were enhanced, indicating spinal hyperexcitability. We found an increase in density of nociceptive sensory afferences and in GABA inhibitory activity in dorsal horns, and increased glial reactivity. Serotoninergic descending fibers and contacts on ventral horn motoneurons were reduced. Motoneurons presented more abundant inhibitory inputs, identified by gephyrin. Not all the changes kept direct relationship to the severity of the injury. The existence of hyperalgesia despite the boost of inhibitory elements in the spinal cord confirms the dysbalance between excitatory and inhibitory mechanisms, leading to a general disinhibition. Widespread dysfunctions in remote segments after central injuries contribute to the appearance of pain, and they may be new targets for therapies aimed to modulate spinal dysfunctions after injury.

  18. Complications related to the use of spinal cord stimulation for managing persistent postoperative neuropathic pain after lumbar spinal surgery.

    PubMed

    Shamji, Mohammed F; Westwick, Harrison J; Heary, Robert F

    2015-10-01

    OBJECT Structural spinal surgery yields improvement in pain and disability for selected patients with spinal stenosis, spondylolisthesis, or a herniated intervertebral disc. A significant fraction of patients exhibit persistent postoperative neuropathic pain (PPNP) despite technically appropriate intervention, and such patients can benefit from spinal cord stimulation (SCS) to alleviate suffering. The complication profile of this therapy has not been systematically assessed and, thus, was the goal of this review. METHODS A comprehensive literature search was performed to identify prospective cohorts of patients who had PPNP following structurally corrective lumbar spinal surgery and who underwent SCS device implantation. Data about study design, technique of SCS lead introduction, and complications encountered were collected and analyzed. Comparisons of complication incidence were performed between percutaneously and surgically implanted systems, with the level of significance set at 0.05. RESULTS Review of 11 studies involving 542 patients formed the basis of this work: 2 randomized controlled trials and 9 prospective cohorts. Percutaneous implants were used in 4 studies and surgical implants were used in 4 studies; in the remainder, the types were undefined. Lead migration occurred in 12% of cases, pain at the site of the implantable pulse generator occurred in 9% of cases, and wound-related complications occurred in 5% of cases; the latter 2 occurred more frequently among surgically implanted devices. CONCLUSIONS Spinal cord stimulation can provide for improved pain and suffering and for decreased narcotic medication use among patients with PPNP after lumbar spinal surgery. This study reviewed the prospective studies forming the evidence base for this therapy, to summarize the complications encountered and, thus, best inform patients and clinicians considering its use. There is a significant rate of minor complications, many of which require further surgical

  19. Surgical treatment of spinal lipoma without spina bifida at lumbar region-three case reports-.

    PubMed

    Sugawara, Atsushi; Kim, Kyongsong; Isobe, Masanori; Matsumoto, Ryoji; Isu, Toyohiko

    2009-12-01

    Three men aged 40 to 60 years presented with rare lumbar spinal intradural lipomas without spina bifida manifesting as worsening numbness, pain of the lower extremities, and bladder dysfunction. All 3 patients underwent decompressive laminectomy. The lipoma and cauda equina nerves were dissected from the dura mater under the operating microscope, untethering the spinal cord and returning the cauda equina nerves to the original position. Duralplasty was performed using an expanded polytetrafluoroethylene sheet. Postoperatively, all patients experienced improvement of their neurological deficits. In the surgical treatment of spinal lipomas, the primary purpose is untethering and decompression, which can be achieved by untethering the spinal cord, returning the cauda equina nerves to the normal position, laminectomy, and duralplasty, without removal of the lipoma.

  20. Thoracic Meningioma In Combination With Severe Lumbar Spinal Stenosis Presenting With Atypical Neurological Deficit.

    PubMed

    Kehayov, Ivo I; Raykov, Stephan D; Hubavenska, Iveta N; Davarski, Atanas N; Kitova, Tanya T; Zhelyazkov, Christo B; Kitov, Borislav D

    2015-01-01

    We report on a case of a 47-year-old female patient with a long history of low back pain irradiating bilaterally to the legs. Twenty days before admission to our clinic, she had developed progressive weakness in the legs, more pronounced on the left side. The initial neurological examination revealed signs of damage to both the cauda equina and the spinal cord. The neuroimaging studies (computed tomography, myelography and magnetic-resonance tomography) found spinal stenosis most severe at L4-L5 level, and right lateral thoracic intradural-extramedullary tumor at T9-T10 level. The patient underwent two neurosurgical procedures. The first stage included microsurgical resection of the thoracic lesion and the second stage aimed at decompressing the lumbar spinal stenosis. To avoid missing a diagnosis of thoracic lesions, it is necessary to perform a thorough neurological examination of the spinal cord motor and sensory functions. In addition, further MRI examination of upper spinal segment is needed if the neuroimaging studies of the lumbar spine fail to provide reasonable explanation for the existing neurological symptoms.

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

    PubMed

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

    2015-01-01

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

  2. Lumbar spinal stenosis: clinical/radiologic therapeutic evaluation in 145 patients. Conservative treatment or surgical intervention?

    PubMed

    Onel, D; Sari, H; Dönmez, C

    1993-02-01

    In this prospective study, 145 patients with lumbar spinal stenosis were evaluated for clinical signs and radiologic findings and conservative treatment results. Clinical parameters such as pain on motion, lumbar range of motion, straight leg raising test, deep tendon reflexes, dermatomal sensations, motor functions and neurogenic claudication distances were assessed at admission and were compared after a conservative treatment program was completed. A conservative treatment program consisted of physical therapy (infrared heating, ultrasonic diathermy and active lumbar exercises) and salmon calcitonin. Pain on motion (100%), restriction of extension (77%), limited straight leg raising test (23%), neurogenic claudication (100%), dermatomal sensory impairment (47%), motor deficit (29%), and reflex deficit (40%) were observed in the patients. All aforementioned disturbances except reflex deficits improved by the conservative treatment and results were statistically significant. The authors conclude that this conservative treatment should be the treatment of choice in elderly patients and in those patients without clinical surgical indications.

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

    PubMed Central

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

    2010-01-01

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

  4. Characterization of subchondral bone histopathology of facet joint osteoarthritis in lumbar spinal stenosis.

    PubMed

    Netzer, Cordula; Urech, Karin; Hügle, Thomas; Benz, Robyn Melanie; Geurts, Jeroen; Schären, Stefan

    2016-08-01

    Facet joint osteoarthritis may be a cause of low back pain in degenerative spine diseases including lumbar spinal stenosis. Subchondral bone is regarded as a potential therapeutic target for osteoarthritis treatment. The goal of this study was to characterize subchondral bone histopathology in osteoarthritic facet joints from lumbar spinal stenosis patients. Fifteen patients with degenerative spinal stenosis scheduled for transforaminal lumbar interbody fusion surgery were recruited for this study. Osteoarthritis severity was graded on T1- and T2-weighted MRI images using Weishaupt scoring system. Dissected osteoarthritic facet joints were subjected to histological and immunohistochemistry analyses to study relative abundance of osteoblast, osteoclasts, and macrophages using van Gieson's, tartrate-resistant acid phosphatase and CD68-antibody staining, respectively. Presence of nerve fibers was evaluated by PGP9.5-antibody staining. Differential bone histopathology, independent from radiological osteoarthritis grade, was observed in facet joints. Extensive de novo bone formation was found in subchondral bone tissues of eight of fifteen specimens. Regions of bone formation showed high abundance of blood vessels and CD68-positive macrophages, but were devoid of multinucleated osteoclasts. Additional pathological changes in subchondral marrow spaces, including inflammatory infiltration and enhanced osteoclast activity, were characterized by macrophage-rich tissues. PGP9.5-positive nerve fibers were detected near arterioles, but not in regions displaying bone pathology. Individual histopathological parameters did not associate with clinical features or radiological osteoarthritis severity. Subchondral bone histopathology of facet joint osteoarthritis in lumbar spinal stenosis is characterized by marrow infiltration by macrophage-rich tissues and enhanced de novo bone formation. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34

  5. Two Portal Percutaneous Endoscopic Decompression for Lumbar Spinal Stenosis: Preliminary Study

    PubMed Central

    Dilokhuttakarn, Thitinut

    2016-01-01

    Study Design Retrospective. Purpose To report the outcomes of patients with lumbar spinal stenosis treated with percutaneous endoscopic decompression, focusing on the results of clinical evaluations. Overview of Literature There are no studies about two portal percutaneous endoscopic decompression in the treatment of lumbar spinal stenosis. Methods Medical and surgical complications were examined and clinical results were analyzed for 30 patients who consecutively underwent two portal percutaneous endoscopic decompression for lumbar spinal stenosis were reviewed. The operations were performed by unilateral laminotomy for bilateral decompression. Results All patients displayed clinical improvement when were evaluated with visual analog scale (VAS) score of pain, Oswestry disability index (ODI) and Macnab criteria. The improvement of VAS and ODI was 8.3±0.7 to 2.3±2.6 and 65.2±13.7 to 24.0±15.5, respectively (both p<0.05). Complications were the same as for open decompression. The most common complication was transient nerve root paresthesia. Conclusions Surgical decompression with two portal percutaneous endoscopic decompression has initial benefits, but long-term studies should pay more attention to the risks of postoperative instability and restenosis as well as the need for re-operation. Further investigations with long-term results are thus required. PMID:27114776

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

    PubMed Central

    Chhabra, Harvinder Singh; Kapoor, Kulwant Singh

    2014-01-01

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

  7. Can patient characteristics predict benefit from epidural corticosteroid injections for lumbar spinal stenosis symptoms?

    PubMed

    Turner, Judith A; Comstock, Bryan A; Standaert, Christopher J; Heagerty, Patrick J; Jarvik, Jeffrey G; Deyo, Richard A; Wasan, Ajay D; Nedeljkovic, Srdjan S; Friedly, Janna L

    2015-11-01

    Epidural corticosteroid injections are commonly used to treat back and leg pain associated with lumbar spinal stenosis. However, little is known about which patient characteristics may predict favorable responses. The aim was to identify patient characteristics associated with benefits from epidural injections of corticosteroid with lidocaine versus epidural injections of lidocaine only for lumbar spinal stenosis symptoms. This was a secondary analysis of Lumbar Epidural steroid injections for Spinal Stenosis randomized controlled trial data from 16 US clinical sites. Patients aged older than or equal to 50 years with moderate-to-severe leg pain and lumbar central spinal stenosis randomized to epidural injections of corticosteroids with lidocaine (n=200) or lidocaine only (n=200) were included. Primary outcomes were the Roland-Morris Disability Questionnaire (RMDQ) and 0 to 10 leg pain intensity ratings. Secondary outcomes included the Brief Pain Inventory Interference Scale and the Swiss Spinal Stenosis Questionnaire. At baseline, clinicians rated severity of patient spinal stenosis, and patients completed predictor and outcome measures. Patients completed outcome measures again 3 and 6 (primary end point) weeks after randomization/initial injection. Analysis of covariance was used with treatment by covariate interactions to identify baseline predictors of greater benefit from corticosteroid+lidocaine versus lidocaine alone. We also identified nonspecific (independent of treatment) predictors of outcomes. Among 21 candidate predictors and six outcomes, only one baseline variable predicted greater benefit from corticosteroid+lidocaine versus lidocaine only at 3 or 6 weeks. Compared with patients who rated their health-related quality of life as high on the EQ-5D Index, patients who rated it as poor had greater improvement with corticosteroid than with lidocaine only in leg pain at 6 (but not 3) weeks (interaction coefficient=2.94; 95% confidence interval [CI]=0

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

    PubMed

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

    2007-11-01

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

  9. Abnormal DNA methylation in the lumbar spinal cord following chronic constriction injury in rats.

    PubMed

    Wang, Ying; Lin, Zhi-Ping; Zheng, Hui-Zhe; Zhang, Shuang; Zhang, Zong-Luan; Chen, Yan; You, Yi-Sheng; Yang, Ming-Hua

    2016-01-01

    Pathogenesis of neuropathic pain is complex and not clearly understood. Glutamate decarboxylase 67 (GAD 67) is a key synthetic enzyme for the main inhibitory transmitter gamma-aminobutyric acid (GABA), and diminishes in the spinal dorsal horn in rats following chronic constriction injury (CCI). GAD 67 is coded by gene GAD 1. DNA methylation can regulate the expression of GAD 67 by regulating the methylation of GAD 1 promoter in the psychotic brain. DNA methylation is primarily mediated by DNA methyltransferases (DNMTs) and methyl-DNA binding domain proteins (MBDs). In this study, in order to discover whether DNA methylation regulates GAD 67 expression in the spinal cord in CCI rats and is involved in neuropathic pain, we examined mRNA levels of DNMTs, MBDs and GAD 67 with real-time reverse transcriptase-polymerase chain reaction (qRT-PCR), and methylation of GAD 1 promoter with Pyromark CpG Assays in the lumbar spinal cord in CCI rats on day 14 after surgery. Our results showed that DNMT3a, DNMT3b and methyl-CpG binding protein 2 (MeCP2) expression increased, MBD2 expression decreased, and DNMT1, MBD1 and MBD3 expression hardly changed in the lumbar spinal cord in CCI rats on day 14 after surgery. GAD 67 expression decreased, and methylation of GAD 1 promoter increased in the lumbar spinal cord in CCI rats on day 14 after surgery. These results indicate that decreased GAD 67 may be associated with increased GAD 1 promoter methylation, which may be mediated by DNMT3a, DNMT3b, MeCP2 and MBD2 in CCI rats. These indicate that abnormal DNA methylation may be highly involved in CCI-induced neuropathic pain.

  10. Suprapedicular Foraminal Endoscopic Approach to Lumbar Lateral Recess Decompression Surgery to Treat Degenerative Lumbar Spinal Stenosis.

    PubMed

    Wang, Ya-Peng; Zhang, Wei; Li, Bao-Li; Sun, Ya-Peng; Ding, Wen-Yuan; Shen, Yong

    2016-11-28

    BACKGROUND To discuss the strategy of suprapedicular foraminal endoscopic approach to lumbar lateral recess decompression and evaluate the safety and effectiveness of this strategy. MATERIAL AND METHODS Complete clinical information of 52 cases of lumbar lateral recess decompression with therapy of suprapedicular foraminal endoscopic approach were analyzed during the period from February 2010 to April 2014 in the Third Hospital of Hebei. All patients were followed up for 24 months, and VAS, JOA, ODI, and LRD were compared between preoperative and postoperative therapy and changes of FA. Intraoperative and postoperative complications were recorded and the safety of the surgery was evaluated. The surgical "excellent" and "good" rates were evaluated using MacNab score. RESULTS VAS scores for lumbago and leg pain at 3, 6, 12, and 24 months after surgery were significantly lower than before surgery (p<0.05). JOA scores at 12 and 24 months after surgery were significantly higher than before surgery (p<0.05). ODI at 12 and 24 months after surgery were significantly lower than before surgery (p<0.05). LRD after surgery was higher (p<0.05), and FA was lower than before surgery. CONCLUSIONS Use of the suprapedicular foraminal endoscopic approach to lumbar lateral recess decompression is safe and effective, and this minimally invasive treatment can achieve satisfactory results, especially for elderly patients with complicated underlying diseases.

  11. Traumatic lumbar artery rupture after lumbar spinal fracture dislocation causing hypovolemic shock: An endovascular treatment.

    PubMed

    Eun, Jong-Pil; Oh, Young-Min

    2015-01-01

    Recently, we observed a case of lumbar artery injury after trauma, which was treated by endovascular embolization. A 67-year-old woman who was injured in a traffic accident was brought to the emergency room. She was conscious and her hemodynamic condition was stable, but she had paraplegia below L1 dermatome. Contrast-enhanced computed tomography scan of abdomen and pelvis revealed fracture dislocation of L3/4 along with retroperitoneal hematomas. However, there was no evidence of traumatic injury in both thoracic and abdominal cavity. At that time, her blood pressure suddenly decreased to 60/40 mmHg and her mental status deteriorated. Also, her hemoglobin level was 5.4 g/dl. While her hemodynamic condition stabilized with massive fluid resuscitation including blood transfusion, an angiography was immediately performed to look for and embolize site of retroperitoneal hemorrhage. On the angiographic images, there was an active extravasation from ruptured left 3rd lumbar artery, and we performed complete embolization with GELFOAM and coil. Lumbar artery injury after trauma is rare and endovascular treatment is useful in case of hemodynamic instability.

  12. Suprapedicular Foraminal Endoscopic Approach to Lumbar Lateral Recess Decompression Surgery to Treat Degenerative Lumbar Spinal Stenosis

    PubMed Central

    Wang, Ya-peng; Zhang, Wei; Li, Bao-li; Sun, Ya-peng; Ding, Wen-yuan; Shen, Yong

    2016-01-01

    Background To discuss the strategy of suprapedicular foraminal endoscopic approach to lumbar lateral recess decompression and evaluate the safety and effectiveness of this strategy. Material/Methods Complete clinical information of 52 cases of lumbar lateral recess decompression with therapy of suprapedicular foraminal endoscopic approach were analyzed during the period from February 2010 to April 2014 in the Third Hospital of Hebei. All patients were followed up for 24 months, and VAS, JOA, ODI, and LRD were compared between preoperative and postoperative therapy and changes of FA. Intraoperative and postoperative complications were recorded and the safety of the surgery was evaluated. The surgical “excellent” and “good” rates were evaluated using MacNab score. Results VAS scores for lumbago and leg pain at 3, 6, 12, and 24 months after surgery were significantly lower than before surgery (p<0.05). JOA scores at 12 and 24 months after surgery were significantly higher than before surgery (p<0.05). ODI at 12 and 24 months after surgery were significantly lower than before surgery (p<0.05). LRD after surgery was higher (p<0.05), and FA was lower than before surgery. Conclusions Use of the suprapedicular foraminal endoscopic approach to lumbar lateral recess decompression is safe and effective, and this minimally invasive treatment can achieve satisfactory results, especially for elderly patients with complicated underlying diseases. PMID:27890911

  13. Noradrenergic Modulation of Intrinsic and Synaptic Properties of Lumbar Motoneurons in the Neonatal Rat Spinal Cord

    PubMed Central

    Tartas, Maylis; Morin, France; Barrière, Grégory; Goillandeau, Michel; Lacaille, Jean-Claude; Cazalets, Jean-René; Bertrand, Sandrine S.

    2009-01-01

    Although it is known that noradrenaline (NA) powerfully controls spinal motor networks, few data are available regarding the noradrenergic (NAergic) modulation of intrinsic and synaptic properties of neurons in motor networks. Our work explores the cellular basis of NAergic modulation in the rat motor spinal cord. We first show that lumbar motoneurons express the three classes of adrenergic receptors at birth. Using patch-clamp recordings in the newborn rat spinal cord preparation, we characterized the effects of NA and of specific agonists of the three classes of adrenoreceptors on motoneuron membrane properties. NA increases the motoneuron excitability partly via the inhibition of a KIR like current. Methoxamine (α1), clonidine (α2) and isoproterenol (β) differentially modulate the motoneuron membrane potential but also increase motoneuron excitability, these effects being respectively inhibited by the antagonists prazosin (α1), yohimbine (α2) and propranolol (β). We show that the glutamatergic synaptic drive arising from the T13-L2 network is enhanced in motoneurons by NA, methoxamine and isoproterenol. On the other hand, NA, isoproterenol and clonidine inhibit both the frequency and amplitude of miniature glutamatergic EPSCs while methoxamine increases their frequency. The T13-L2 synaptic drive is thereby differentially modulated from the other glutamatergic synapses converging onto motoneurons and enhanced by presynaptic α1 and β receptor activation. Our data thus show that the NAergic system exerts a powerful and complex neuromodulation of lumbar motor networks in the neonatal rat spinal cord. PMID:20300468

  14. Lumbar Spinal Stenosis with Exacerbation of Back Pain with Extension: Potential Contraindication For Supine MRI With Sedation

    PubMed Central

    Kuramoto, Alan; Chang, Linda; Grahm, Jon; Holmes, Stephen

    2011-01-01

    A 71-year-old male with lumbar spinal stenosis developed exacerbation of lower back pain and leg paresthesias while attempting to undergo a spinal MRI scan in the supine position. After undergoing sedation for the MRI, he developed an acute cauda equina syndrome that required surgical decompression. MRI may be contraindicated in the supine position for patients with spinal stenosis and back pain exacerbated by mild to moderate extension, since it may further compress the neural tissue. PMID:19490371

  15. Dynamic Lumbar Spinal Stenosis : The Usefulness of Axial Loaded MRI in Preoperative Evaluation

    PubMed Central

    Choi, Kyung-Chul; Jung, Byungjoo; Lee, Sang-Ho

    2009-01-01

    Two cases of dynamic lumbar spinal stenosis were identified by the authors using axial loaded magnetic resonance image (MRI). In both cases, the patients presented with neurogenic claudication but MRI in decumbency showed no definite pathologic condition associated with their symptoms. In contrast, axial loaded MRI demonstrated constrictive spinal stenosis and a significantly decreased dural sac caused by epidural fat buckling and thickening of the ligamentum flavum in both cases. In the second case, a more prominent disc protrusion was also demonstrated compared with decumbent MRI. After decompressive surgery, both patients had satisfactory outcomes. Axial loaded MRI can therefore give decisive information in dynamic spinal disorders by allowing simulation of an upright position. PMID:19844630

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

    PubMed

    Syrimpeis, Vasileios; Vitsas, Vasileios; Korovessis, Panagiotis

    2014-03-01

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

  17. Prostaglandin E1 Treatment for Lumbar Spinal Canal Stenosis: Review of the Literature.

    PubMed

    Yoshihara, Hiroyuki

    2016-02-01

    The important pathophysiologic factor of neurogenic intermittent claudication (NIC) in lumbar spinal canal stenosis (LSCS) has been reported to be the reduction in intraneural blood flow and a state of relative ischemia in nerve tissues. Prostaglandin E1 (PGE1) presumably improves symptoms in patients with LSCS by improving the blood flow in the cauda equina and nerve roots through its vasodilation and antiplatelet aggregation effects. The purpose of the study was to summarize the results of previous studies regarding PGE1 treatment for LSCS and to describe the details of PGE1 treatment to all physicians who take care of patients with LSCS. Review of the literature. There are 3 PGE1-related products that have been used clinically for the treatment of LSCS: PGE1, lipo-PGE1, and limaprost (PGE1 derivative). Experimental studies have been performed to verify the efficacy of PGE1 treatment for LSCS. Many studies have reported clinical outcomes of PGE1 treatment in patients with LSCS. Overall, previous studies examining PGE1 treatment for LSCS demonstrate improvement in several clinical outcome measures such as the visual analog scale, Japanese Orthopaedic Association score, and NIC distance, although most of the studies have only short-term follow-up. Based on the results of previous studies, PGE1 treatment may be an option as a conservative treatment for LSCS. However, future studies with high-quality and long-term follow-up are necessary. Future studies also should include refinement of indications, administration period, as well as comparisons between PGE1 treatment and other conservative treatments such as epidural injection. © 2015 World Institute of Pain.

  18. Biportal Endoscopic Spinal Surgery for Recurrent Lumbar Disc Herniations

    PubMed Central

    Jung, Je-Tea; Lee, Sang-Jin; Kim, Young-Sang; Jang, Han-Jin; Yoo, Bang

    2016-01-01

    The major problems of revision surgery for recurrent lumbar disc herniation (LDH) include limited visualization due to adhesion of scar tissue, restricted handling of neural structures in insufficient visual field, and consequent higher risk of a dura tear and nerve root injury. Therefore, clear differentiation of neural structures from scar tissue and adhesiolysis performed while preserving stability of the remnant facet joint would lower the risk of complications and unnecessary fusion surgery. Biportal endoscopic spine surgery has several merits including sufficient magnification with panoramic view under very high illumination and free handling of instruments normally impossible in open spine surgery. It is supposed to be a highly recommendable alternative technique that is safer and less destructive than the other surgical options for recurrent LDH. PMID:27583117

  19. Readmission rates after decompression surgery in patients with lumbar spinal stenosis among Medicare beneficiaries.

    PubMed

    Modhia, Urvij; Takemoto, Steven; Braid-Forbes, Mary Jo; Weber, Michael; Berven, Sigurd H

    2013-04-01

    Retrospective observational cohort analysis of administrative claims. Estimate readmission rates after spine stenosis decompression surgery in a 5% randomly selected sample of Medicare beneficiaries. Operative management of lumbar spinal stenosis has significant and measurable benefits compared with nonoperative care. Revision rates for lumbar decompression with and without fusion have been reported with significant variability. An understanding of readmission and reoperation rates informs decisions regarding the cost-effective management of lumbar stenosis. Patients were identified in 2005-2009 Medicare claims who had both a procedure code for decompression (03.09), and a diagnosis of lumbar spinal stenosis (724.02). Patients diagnosed with spondylolisthesis, and those receiving revision surgery or fusion of more than 3 segments were excluded. Kaplan-Meier product limit method was used to estimate univariate rates of readmission for fusion, decompression, or injection and Cox proportional hazards to examine whether fusion decreased the likelihood of readmission. The overall 1-year readmission rate was slightly higher in patients undergoing fusion with decompression (9.7%) than patients who underwent decompression alone (7.2%, P = 0.03). Rates at 2 years were 14.6% and 12.5%, respectively. Patients receiving decompression with fusion were slightly younger and more likely female. Procedures performed during readmission were similar for the fusion and no fusion cohorts with 56% receiving fusion, 23% decompression, and 22% injection for pain management. Of the patients who were not readmitted, more than 25% of patients received outpatient injections for pain management during the 3-month quarter of their surgery and approximately 20% in the subsequent quarter. Readmission rates for spinal stenosis decompression were approximately 8% to 10% per year. Fusion at the index procedure did not protect against subsequent readmission. Large databases can inform choice of

  20. Histopathological Analysis of Ligamentum Flavum in Lumbar Spinal Stenosis and Disc Herniation

    PubMed Central

    Yüksel, Kasım Zafer

    2017-01-01

    Study Design Histopathological analyses were performed in ligamentum flavum (LF) hypertrophy patients with lumbar spinal stenosis (LSS) and lumbar disc herniation (LDH). Purpose The aim of the present study was to evaluate histopathological changes in LF patients with LSS and LDH. Overview of Literature LSS is the most common spinal disorder in elderly patients. This condition causes lower back and leg pain and paresis, and occurs as a result of degenerative changes in the lumbar spine, including bulging of the intervertebral discs, bony proliferation of the facet joints, and LF thickening; among these, LF thickening is considered a major contributor to the development of LSS. Methods A total of 71 patients operated with the surgical indications of LSS and LDH were included. LF samples were obtained from 31 patients who underwent decompressive laminectomy for symptomatic degenerative LSS (stenotic group) and from 40 patients who underwent lumbar discectomy for LDH (discectomy group). LF materials were examined histopathologically, and other specimens were examined for collagen content, elastic fiber number and array, and presence of calcification. Results The stenotic and discectomy groups did not differ with regard to mean collagen concentration or mean elastic fiber number (p=0.430 and p=0.457, respectively). Mean elastic fiber alignment was 2.36±0.99 in the stenotic group and 1.38±0.54 in the discectomy group (p<0.001). Mean calcification was 0.39±0.50 in the stenotic group, whereas calcification was not detected (0.00±0.00) in the discectomy group; a statistically significant difference was detected (p<0.001) between groups. Conclusions LF hypertrophy in spinal stenosis may occur as a result of elastic fiber misalignment along with the development of calcification over time. Further studies determining the pathogenesis of LSS are needed. PMID:28243372

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

    PubMed

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

    2013-01-01

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

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

    PubMed Central

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

    2013-01-01

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

  3. Is sheep lumbar spine a suitable alternative model for human spinal researches? Morphometrical comparison study

    PubMed Central

    Berner, Dagmar; Jülke, Henriette; Hohaus, Christian; Brehm, Walter; Gerlach, Kerstin

    2013-01-01

    Sheep are commonly used as a model for human spinal orthopaedic research due to their similarity in morphological and biomechanical features. This study aimed to document the volumes of vertebral bodies and compare the generated results as well as morphometry of the sheep lumbar spine to human published data. For this purpose, computed tomography scans were carried out on five adult Merino sheep under general anaesthesia. Transverse 5 mm thick images were acquired from L1 to L6 using a multi-detector-row helical CT scanner. Volume measurements were performed with dedicated software. Four spinal indices and Pavlov's ratio were calculated. Thereafter, the generated data were compared to published literature on humans. The mean vertebral body volume showed an increase towards the caudal vertebrae, but there were no significant differences between the vertebral levels (P>0.05). Compared to humans, sheep vertebral body volumes were 48.6% smaller. The comparison of absolute values between both species revealed that sheep had smaller, longer and narrower vertebral bodies, thinner intervertebral discs, narrower spinal canal, longer transverse processes, shorter dorsal spinous processes and narrower, higher pedicles with more lateral angulations. The comparison of the spinal indices showed a good similarity to human in terms of the vertebral endplates and spinal canal. The results of this study may be helpful for using the sheep as a model for human orthopaedic spinal research if anatomical differences are taken into account. PMID:24396382

  4. Comparison of postoperative clinical outcome after repairing surgery for lumbar spinal stenosis between diabetic and nondiabetic patients.

    PubMed

    Afsharian, Tahmineh; Azhari, Shirzad; Mostafazadeh, Babak

    2017-01-01

    Poorer postoperative outcome is suggested after repairing surgery in diabetic patients with lumbar spinal stenosis in comparison with nondiabetic patients. The present study aimed to compare the clinical outcome of surgery for lumbar spinal stenosis and diabetic and nondiabetic patients to highlight the effect of diabetes on prognosis of this surgical procedure. This prospective cohort study is conducted on 25 diabetic patients with lumbar spinal stenosis who were candidate for surgical treatment. A gender, age, and body mass index-matched group including 30 nondiabetic patients with lumbar spinal stenosis was considered as the control. The clinical condition of the patients was assessed based on oswestry disability index (ODI) before and immediately after surgery. There was no difference in baseline ODI index between diabetes and diabetes group (73.68 ± 18.89 vs. 71.20 ± 18.27, P = 0.625), whereas postprocedure ODI was significantly higher in diabetic patients than in nondiabetic group (54.32 ± 19.03 vs. 29.47 ± 18.75, P < 0.001). The multivariable logistic regression analysis could show a difference in postoperative ODI between diabetic and nondiabetic patients with the presence of baseline variables as the confounders (beta = -24.509, P < 0.001). Lower improvement in physical ability is expected in diabetic patients after surgery for lumbar spinal stenosis when compared to nondiabetes patients.

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

    PubMed

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

    2017-09-01

    To investigate the effect of zoledronic acid (ZA) on lumbar spinal fusion in patients with osteoporosis. This retrospective study includes 94 osteoporotic patients suffering from lumbar degenerative diseases or lumbar fracture who underwent lumbar spinal fusion in our institution from January 2013 to August 2014. They were divided into ZA group and control group according to whether the patient received ZA infusion or not. The patients in ZA group were given 5 mg intravenous ZA at the 3rd-5th days after operation. All patients took daily oral supplement of 600 mg calcium carbonate and 800 IU vitamin D during the follow-up after operation. The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and Short Form 36 (SF-36) scores were recorded preoperatively and post-operatively to evaluate the clinic outcomes; the spinal fusion was assessed by X-ray or CT Scan. 64 patients finished the final follow-up, including 30 patients in ZA group and 34 patients in control group. No significant difference was observed in gender, age, and preoperative BMI VAS, ODI, and SF-36 scores between the two groups (P > 0.05). The post-operative VAS and ODI scores decreased rapidly at 3 and 6 months, but rose back slightly at 12 and 24 months in both groups. On the contrary, post-operative SF-36 scores increased rapidly at 3 and 6 months, while fell back slightly at 12 and 24 months, with a statistically significant difference between the two groups at 12 months, but not at 3 and 6 month post-operation. The spinal fusion rate in ZA group was 90% at 6 months, 92% at 12 months, while it was 75% at 6 months, 92.86% at 12 months in control group, significantly different between the two groups at 12 months, but not at 6 months. In the whole follow-up period, adjacent vertebral compressing fracture occurred in five patients in control group, none in ZA group. No pedicle screw loosening was observed in ZA group, with six in control group. Zoledronic acid accelerates

  6. The effect of lumbar sympathectomy on increased tactile sensitivity in spinal nerve ligated rats.

    PubMed

    Lee, D H; Katner, J; Iyengar, S; Lodge, D

    2001-02-02

    The aim of this study was to investigate the reason for the contradictory results following surgical sympathectomy on increased tactile sensitivity in spinal nerve ligated rats. For this purpose, firstly the results of L5 spinal nerve ligation alone and both L5 and L6 (L5/6) spinal nerve ligation were compared in Sprague-Dawley rats. Secondly, the difference in tactile sensitivity between the plantar surface (the middle glabrous area on the foot pads of the hind paw) and on the toe (the proximal half of the third and fourth toe of the hind paw) after the spinal nerve injury was studied. Third, we divided the L5 spinal nerve ligated rats into two groups, (i.e. low and high threshold groups) based on the degree of tactile sensitivity and investigated the effect of surgical lumbar sympathectomy (L2-L5) on tactile sensitivity in both the plantar and toe areas. The results show that the tactile sensitivities of L5 spinal nerve ligated rats and L5/6 spinal nerve ligated rats were not different. However, tactile sensitivities of the plantar surface were less than those of toe area suggesting that the response from toe is a better indicator of neuropathic pain. Surgical sympathectomy reduced the response from only the toe area and only in the low threshold group. These results suggest that the reason for the contradictory results of surgical sympathectomy in spinal nerve ligation models is, at least in part, the difference in the degree of mechanical allodynia in each study.

  7. Using Magnetic Resonance Myelography to Improve Interobserver Agreement in the Evaluation of Lumbar Spinal Canal Stenosis and Root Compression

    PubMed Central

    Al-Essawi, Sattar; Shukri, Mahmud; Naji, Farah Kasim

    2017-01-01

    Study Design Cross-sectional retrospective study designed to assess interobserver agreement. Purpose To investigate if interobserver agreement using magnetic resonance imaging (MRI) in the evaluation of lumbar spinal canal stenosis and root compression can be improved upon combination with magnetic resonance myelography (MRM). Overview of Literature The interpretation of lumbar spinal MRI, which is the imaging modality of choice, often has a significant influence on the diagnosis and treatment of low back pain. However, using MRI alone, substantial interobserver variability has been reported in the evaluation of lumbar spinal canal stenosis and nerve root compression. Methods Hardcopies of 30 lumbar spinal MRI (containing a total of 150 disk levels) as well as MRM films were separately reviewed by two radiologists and a neurosurgeon. At each intervertebral disk, the observers were asked to evaluate the thecal sac for the presence and degree of spinal stenoses (mild, moderate, or severe) and presence of root canal compression. Interobserver agreement was measured using weighted kappa statistics. Results Regarding lumbar spinal canal stenosis, interobserver agreement between the two radiologists was moderate (kappa, 0.4) for MRI and good (kappa, 0.6) for combination with MRM. However, the agreement between the radiologist and neurosurgeon remained fair for MRI alone or in combination with MRM (kappa, 0.38 and 033, respectively). In the evaluation of nerve root compression, interobserver agreement between the radiologists improved from moderate (kappa, 0.57) for MRI to good (kappa, 0.73) after combination with MRM; moderate agreement between the radiologist and neurosurgeon was noted for both MRI alone and after combination with MRM (kappa, 0.58 and 0.56, respectively). Conclusions Interobserver agreement in the evaluation of lumbar spinal canal stenosis and root compression between the radiologists improved when MRM was combined with MRI, relative to MRI alone. PMID

  8. Using Magnetic Resonance Myelography to Improve Interobserver Agreement in the Evaluation of Lumbar Spinal Canal Stenosis and Root Compression.

    PubMed

    Al-Tameemi, Haider Najim; Al-Essawi, Sattar; Shukri, Mahmud; Naji, Farah Kasim

    2017-04-01

    Cross-sectional retrospective study designed to assess interobserver agreement. To investigate if interobserver agreement using magnetic resonance imaging (MRI) in the evaluation of lumbar spinal canal stenosis and root compression can be improved upon combination with magnetic resonance myelography (MRM). The interpretation of lumbar spinal MRI, which is the imaging modality of choice, often has a significant influence on the diagnosis and treatment of low back pain. However, using MRI alone, substantial interobserver variability has been reported in the evaluation of lumbar spinal canal stenosis and nerve root compression. Hardcopies of 30 lumbar spinal MRI (containing a total of 150 disk levels) as well as MRM films were separately reviewed by two radiologists and a neurosurgeon. At each intervertebral disk, the observers were asked to evaluate the thecal sac for the presence and degree of spinal stenoses (mild, moderate, or severe) and presence of root canal compression. Interobserver agreement was measured using weighted kappa statistics. Regarding lumbar spinal canal stenosis, interobserver agreement between the two radiologists was moderate (kappa, 0.4) for MRI and good (kappa, 0.6) for combination with MRM. However, the agreement between the radiologist and neurosurgeon remained fair for MRI alone or in combination with MRM (kappa, 0.38 and 033, respectively). In the evaluation of nerve root compression, interobserver agreement between the radiologists improved from moderate (kappa, 0.57) for MRI to good (kappa, 0.73) after combination with MRM; moderate agreement between the radiologist and neurosurgeon was noted for both MRI alone and after combination with MRM (kappa, 0.58 and 0.56, respectively). Interobserver agreement in the evaluation of lumbar spinal canal stenosis and root compression between the radiologists improved when MRM was combined with MRI, relative to MRI alone.

  9. Magnetic Resonance Imaging of the Cervical, Thoracic, and Lumbar Spine in Children: Spinal Incidental Findings in Pediatric Patients

    PubMed Central

    Ramadorai, Uma E.; Hire, Justin M.; DeVine, John G.

    2014-01-01

    Study Design Retrospective case series. Objective To determine the rate of spinal incidental findings on magnetic resonance imaging (MRI) of the cervical, thoracic, and lumbar spine in the pediatric population. Methods We reviewed MRI imaging of the neuraxial spine in patients less than 18 years of age and documented abnormal spinal findings. We then reviewed the charts of these patients to determine the reason for ordering the study. Those who presented with pain were considered symptomatic. Those who had no presenting complaint were considered asymptomatic. The data were analyzed to break down the rate of spinal incidental findings in the cervical, thoracic, and lumbar spine, respectively. Results Thirty-one of the 99 MRIs had positive findings, with the most common being disk protrusion (51.6%). Spinal incidental findings were most common in the lumbar spine (9.4%) versus the cervical spine (8%) or thoracic spine (4.7%). In this group, Schmorl nodes and disk protrusion were the two most common findings (37.5% each). Other spinal incidental findings included a vertebral hemangioma and a Tarlov cyst. In the thoracic spine, the only spinal incidental finding was a central disk protrusion without spinal cord or nerve root compression. Conclusion MRI is a useful modality in the pediatric patient with scoliosis or complaints of pain, but the provider should remain cognizant of the potential for spinal incidental findings. PMID:25396102

  10. Automatic spinal canal detection in lumbar MR images in the sagittal view using dynamic programming.

    PubMed

    Koh, Jaehan; Chaudhary, Vipin; Jeon, Eun Kyung; Dhillon, Gurmeet

    2014-10-01

    As there is an increasing need for the computer-aided effective management of pathology in lumbar spine, we have developed a computer-aided diagnosis and characterization framework using lumbar spine MRI that provides radiologists a second opinion. In this paper, we propose a left spinal canal boundary extraction method, based on dynamic programming in lumbar spine MRI. Our method fuses the absolute intensity difference of T1-weighted and T2-weighted sagittal images and the inverted gradient of the difference image into a dynamic programming scheme and works in a fully automatic fashion. The boundaries generated by our method are compared against reference boundaries in terms of the Euclidean distance and the Chebyshev distance. The experimental results from 85 clinical data show that our methods find the boundary with a mean Euclidean distance of 3mm, achieving a speedup factor of 167 compared with manual landmark extraction. The proposed method successfully extracts landmarks automatically and fits well with our framework for computer-aided diagnosis in lumbar spine. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Vertebral body Hounsfield units as a predictor of incidental durotomy in primary lumbar spinal surgery.

    PubMed

    Du, Jerry Y; Aichmair, Alexander; Ueda, Haruki; Girardi, Federico P; Cammisa, Frank P; Lebl, Darren R

    2014-04-20

    Retrospective cohort study. To assess the association between vertebral body Hounsfield unit (HU) measurements on quantitative computed tomography and the risk for incidental durotomy (ID). ID during spine surgery has been associated with adverse postoperative sequelae that may require prolonged hospital stay and reoperation. Previously identified independent risk factors include age, revision surgery, and lumbar surgery. ID was prospectively documented in spine surgery patients at a single institution during a 2-year period (incidence: 4%, 191/4,822). Patients with ID were matched 1:1 to a control cohort without ID based on age and sex. Inclusion criteria for both cohorts were primary lumbar surgery and quantitative computed tomographic scans within 1 year of date of surgery. Demographic, radiographical, and intraoperative data, along with dual x-ray absorptiometry t scores, were collected and analyzed. A total of 71 patients with ID met the inclusion criteria (38 male, 33 female). Average age of patients with ID was 63.8 ± 12.9 years (range: 34-85 yr). Computed tomographic scans were acquired 1.5 ± 2.2 months away from date of surgery (range: 0-12 mo). Inter-rater reliability for HU measurements between a fellowship-trained spine surgeon and a research fellow was strong (r = 0.901, P < 0.001). HU values were significantly lower in patients with ID than controls (149.2 ± 60.7 [range: 44.5-301.5] versus 177.0 ± 81.4, [range: 62.0-524.0], respectively; P = 0.023). The area under the receiver operating characteristic curve was 0.603 (P = 0.034). A threshold of 169 HU optimized sensitivity (0.718) and specificity (0.451), and patients with HU value 169 or less were found to be at increased risk for ID (odds ratio: 2.092, 95% confidence interval: 1.042-4.201, P = 0.037). Lower HU value is an accessible clinical marker for increased risk of ID. A threshold value of HU was defined (≤169) that may be used clinically to identify patients at elevated risk for ID

  12. [A synovial cyst accompanied by asymptomatic lumbar vertebral fracture requiring differentiation from spinal metastasis].

    PubMed

    Miura, Isamu; Ujiie, Hiroshi; Nakagawa, Masanori; Saito, Taiichi; Shiono, Saori; Okada, Yoshikazu

    2015-06-01

    We experienced a case with a synovial cyst accompanied by asymptomatic lumbar vertebral fracture that required differentiation from spinal metastasis. An 82-year-old man suffered from right leg and anal pain. Computed tomography (CT) showed L5 spondylolysis. Magnetic resonance images (MRI) revealed an intra spinal cyst and acute lumbar vertebral fracture of L5 vertebral body. The surrounding area of the cyst presented contrast enhancement, and the extradural mass compressed the dural sac. Bone scintigraphy with 99m technetium-MDP demonstrated intense uptake on the right first, fourth, fifth, and seventh ribs and L2, L3, and L5 vertebra. The F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) image demonstrated an increased radiotracer uptake in the L5 vertebra(standardized uptake value(SUV) max=3.5). Spinal metastasis was suspected. Because of the cauda equina compression syndrome, it was surgically removed. Intraoperatively, a well-demarcated extradural cyst was found and compressed the dural sac markedly. The cyst capsule was thin and contained clear, thin fluid with no signs of bleeding. The histological diagnosis was a synovial cyst. His neurological symptoms improved after the surgery. The synovial cyst may enlarge after asymptomatic vertebral fractures.

  13. CHRONIC SPONTANEOUS LUMBAR EPIDURAL HEMATOMA SIMULATING EXTRADURAL SPINAL TUMOR : A CASE REPORT

    PubMed Central

    MATSUI, HIROKI; IMAGAMA, SHIRO; ITO, ZENYA; ANDO, KEI; HIRANO, KENICHI; TAUCHI, RYOJI; MURAMOTO, AKIO; MATSUMOTO, TOMOHIRO; ISHIGURO, NAOKI

    2014-01-01

    ABSTRACT Spinal epidural hematoma (SEH) is an uncommon disorder, and chronic SEHs are rarer than acute SEHs. However, there is few reported involving the bone change of the vertebral body in chronic SEHs. We present a case report of lumbar epidural hematoma that required differentiation from extramedullary spinal tumors by a long process because the CT scan revealed scalloping of the vertebral body and review the relevant literature. A 78-year-old man had experienced a gradual onset of low back pain and excruciating pain in both legs. Lumbar MRI on T1-weighted images revealed a space-occupying lesion with a hyperintense signal relative to the spinal cord with no enhancement on gadolinium adminisration. Meanwhile, T2-weighted images revealed a heterogeneous intensity change, accompanying a central area of hyperintense signals with a hypointense peripheral border at the L4 vertebra. Moreover, the CT scan demonstrated scalloping of the posterior wall of the L4 vertebral body which is generally suspected as the CT finding of spainal tumor. During the epidural space exploration, we found a dark red-colored mass surrounded by a capsular layer, which was fibrous and adhered to the flavum and dura mater. Microscopic histological examination of the resected mass revealed a mixture of the relatively new hematoma and the hematoma that was moving into the connective tissue. Accordingly, the hematoma was diagnosed as chronic SEH. The particular MRI findings of chronic SEHs are helpful for making accurate preoperative diagnoses of this pathology. PMID:25130006

  14. Late effects of radiation on the lumbar spinal cord of guinea pigs: Re-treatment tolerance

    SciTech Connect

    Mason, K.A. ); Withers, H.R.; Chiang, Chi-Shiun )

    1993-07-15

    Using a guinea pig model of lumbar myelopathy, various factors affecting the tolerance of spinal cord to irradiation were assessed: (a) extent of initial injury; (b) time interval between priming and test doses; and (c) animal age at the time of initial radiation treatment. A 3 cm section of lumbar spinal cord of guinea pigs was irradiated with fractionated doses of 4.5 Gy gamma rays given as 9 fractions per week. Guinea pigs were primed with 9 x 4.5 Gy in 7 days which is 60% of the ED[sub 50] for a continuous course of treatment. After 28 or 40 weeks, animal were retreated with 6-14 fractions of 4.5 Gy. Animals were observed for 2 years following the priming dose and both the incidence and latency of myelopathy recorded. Young adult guinea pigs (8 wk old) showed both a decreased radiation tolerance and latency compared to old individuals (40 wk old). At 28 or 40 wk after 9 x 4.5 Gy, only about 8% of the initial injury was remembered in young adult guinea pigs. The amount of residual injury was dependent on the initial damage as a proportion of the tolerance dose. The spinal cord shows a greater capacity for long-term recovery than generally appreciated and re-treatment doses clinically prescribed may be lower than necessary. 8 refs., 3 figs., 2 tabs.

  15. [Penetrating stab injury to the lumbar spinal cord in a child].

    PubMed

    Scheiderer, B; Mild, K; Gebhard, F; Scola, A

    2016-03-01

    This article reports the case of an 8-year-old boy with a knife stab injury to the lumbar spine without neurological deficits. The computed tomography (CT) scan revealed a longitudinal penetration of the conus medullaris at the level of the first lumbar vertebra. The knife blade was extracted and primary closure was carried out on the stab wound. The immediately postoperative magnetic resonance imaging (MRI) as well as the follow-up examinations after 1 and 6 weeks showed no evidence of compressive spinal bleeding, myelopathy or cerebrospinal fluid leakage. In addition, no secondary changes of the neurological status developed. Consequently, in cases of neurologically asymptomatic patients without concomitant injuries the surgical exploration of a stab wound does not seem to be absolutely necessary.

  16. A rat model of chronic syringomyelia induced by epidural compression of the lumbar spinal cord.

    PubMed

    Lee, Ji Yeoun; Kim, Shin Won; Kim, Saet Pyoul; Kim, Hyeonjin; Cheon, Jung-Eun; Kim, Seung-Ki; Paek, Sun Ha; Pang, Dachling; Wang, Kyu-Chang

    2017-02-17

    OBJECTIVE There has been no established animal model of syringomyelia associated with lumbosacral spinal lipoma. The research on the pathophysiology of syringomyelia has been focused on Chiari malformation, trauma, and inflammation. To understand the pathophysiology of syringomyelia associated with occult spinal dysraphism, a novel animal model of syringomyelia induced by chronic mechanical compression of the lumbar spinal cord was created. METHODS The model was made by epidural injection of highly concentrated paste-like kaolin solution through windows created by partial laminectomy of L-1 and L-5 vertebrae. Behavioral outcome in terms of motor (Basso-Beattie-Bresnahan score) and urinary function was assessed serially for 12 weeks. Magnetic resonance images were obtained in some animals to confirm the formation of a syrinx and to monitor changes in its size. Immunohistochemical studies, including analysis for glial fibrillary acidic protein, NeuN, CC1, ED-1, and caspase-3, were done. RESULTS By 12 weeks after the epidural compression procedure, syringomyelia formation was confirmed in 85% of the rats (34 of 40) on histology and/or MRI. The syrinx cavities were found rostral to the epidural compression. Motor deficit of varying degrees was seen immediately after the procedure in 28% of the rats (11 of 40). In 13 rats (33%), lower urinary tract dysfunction was seen. Motor deficit improved by 5 weeks after the procedure, whereas urinary dysfunction mostly improved by 2 weeks. Five rats (13%, 5 of 40) died 1 month postoperatively or later, and 3 of the 5 had developed urinary tract infection. At 12 weeks after the operation, IHC showed no inflammatory process, demyelination, or accelerated apoptosis in the spinal cords surrounding the syrinx cavities, similar to sham-operated animals. CONCLUSIONS A novel experimental model for syringomyelia by epidural compression of the lumbar spinal cord has been created. The authors hope that it will serve as an important research

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

    PubMed

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

    2013-07-01

    The increasing incidence of spinal metastasis, a result of improved systemic therapies for cancer, has spurred a search for an alternative method for the surgical treatment of lumbar metastases. The authors report a single-stage posterior-only approach for resecting any pathological lumbar vertebral segment and reconstructing with a medium to large expandable cage while preserving all neurological structures. The authors conducted a retrospective consecutive case review of 11 patients (5 women, 6 men) with spinal metastases treated at 1 institution with single-stage posterior-only vertebral column resection and reconstruction with an expandable cage and pedicle screw fixation. For all patients, the indications for operative intervention were spinal cord compression, cauda equina compression, and/or spinal instability. Neurological status was classified according to the American Spinal Injury Association impairment scale, and functional outcomes were analyzed by using a visual analog scale for pain. For all patients, a circumferential vertebral column resection was achieved, and full decompression was performed with a posterior-only approach. Each cage was augmented by posterior pedicle screw fixation extending 2 levels above and below the resected level. No patient required a separate anterior procedure. Average estimated blood loss and duration of each surgery were 1618 ml (range 900-4000 ml) and 6.6 hours (range 4.5-9 hours), respectively. The mean follow-up time was 14 months (range 10-24 months). The median survival time after surgery was 17.7 months. Delayed hardware failure occurred for 1 patient. Preoperatively, 2 patients had intractable pain with intact lower-extremity strength and 8 patients had severe intractable pain, lower-extremity paresis, and were unable to walk; 4 of whom regained the ability to walk after surgery. Two patients who were paraplegic before decompression recovered substantial function but remained wheelchair bound, and 2 patients

  18. [Effects of ablation of the hindlimb on the organization of the ventral horn of the spinal cord in the lumbar region of green lizard embryos (Lacerta viridis Laur.)].

    PubMed

    Raynaud, A; Clairambault, P

    1978-01-01

    After extirpation of an hind limb in embryos of Lacerta viridis, numerous motor neuroblasts degenerate on the operated side, in the ventral horn of the lumbar spinal cord and the corresponding motor column is reduced or disappears. The lumbar spinal ganglia are affected and reduced on the operated side.

  19. [Pain-relieving effect of cantharidin blister on lumbar spinal stenosis].

    PubMed

    Rampp, Thomas; Michalsen, Andreas; Lüdtke, Rainer; Musial, Frauke; Kremer, Gerd; Dobos, Gustav J

    2009-08-01

    Lumbar spinal stenosis (LSS) is a common cause of chronic lumbar pain and disability. Conventional therapy approaches include analgesics and spinal surgery. Topical cantharidin applications are used for the treatment of severe chronic lumbar pain in traditional European medicine (TEM). We tested the pain-relieving effect of lumbar cantharidin blisters in a non-randomised controlled pilot study. 28 consecutive patients with manifest LSS were included. The first 20 patients received a cantharidin blister, 8 patients served as controls (waiting list). Pain was assessed by means of a numeric visual analogue scale (VAS; 0 indicating no pain, 10 indicating strongest pain). Treatment started after a 3-day run-in phase, the blister was applied once for 12 h. Patients were comparable with respect to baseline pain. In the blister group, the pain score continuously improved from 7.2 +/- 2.1 at baseline to 2.9 +/- 2.3 (VAS) at day 7, whereas the score remained unchanged in control patients. Adjusted for baseline, the difference between the blister and the control group was estimated at 4.1 (95% CI: 2.4-5.9, p < 0.0001). The use of analgesics was slightly higher in the control group. No serious adverse events were observed. In this first study on the efficacy of cantharidin blisters, a clinically relevant pain-relieving short-term effect on LSS was observed. As the trial was non-randomised and only included a limited number of patients, the results should be interpreted with caution. Copyright 2009 S. Karger AG, Basel.

  20. Neurogenic period of ascending tract neurons in the upper lumbar spinal cord of the rat

    SciTech Connect

    Nandi, K.N.; Beal, J.A.; Knight, D.S. )

    1990-02-01

    Although the neurogenic period for neurons in the lumbar spinal cord has been clearly established (Days 12 through 16 of gestation), it is not known when the neurogenesis of ascending tract neurons is completed within this period. The purpose of the present study was to determine the duration of the neurogenic period for projection neurons of the ascending tracts. To label neurons undergoing mitosis during this period, tritiated thymidine was administered to fetal rats on Embryonic (E) Days E13 through E16 of gestation. Ascending tract neurons of the lumbar cord were later (Postnatal Days 40-50) labeled in each animal with a retrograde tracer, Fluoro-Gold, applied at the site of a hemisection at spinal cord segment C3. Ascending tract neurons which were undergoing mitosis in the upper lumbar cord were double labeled, i.e., labeled with both tritiated thymidine and Fluoro-Gold. On Day E13, 89-92% of the ascending tract neurons were double labeled; on Day E14, 35-37%; and on Day E15, 1-4%. Results showed, then, that some ascending tract neurons were double labeled through Day E15 and were, therefore, proliferating in the final one-third of the neurogenic period. Ascending tract neurons proliferating on Day E15 were confined to laminae III, IV, V, and X and the nucleus dorsalis. Long tract neurons in the superficial dorsal horn (laminae I and II), on the other hand, were found to have completed neurogenesis on Day E14 of gestation. Results of the present study show that spinal neurogenesis of ascending projection neurons continues throughout most of the neurogenic period and does not completely follow the well-established ventral to dorsal gradient.

  1. Interdisciplinary Cognitive-Behavioral Therapy as Part of Lumbar Spinal Fusion Surgery Rehabilitation

    PubMed Central

    Lindgreen, Pil; Rolving, Nanna; Nielsen, Claus Vinther; Lomborg, Kirsten

    2016-01-01

    BACKGROUND: Patients receiving lumbar spinal fusion surgery often have persisting postoperative pain negatively affecting their daily life. These patients may be helped by interdisciplinary cognitive-behavioral therapy which is recognized as an effective intervention for improving beneficial pain coping behavior, thereby facilitating the rehabilitation process of patients with chronic pain. PURPOSE: The purpose of this study was to describe the lived experience of patients recovering from lumbar spinal fusion surgery and to explore potential similarities and disparities in pain coping behavior between receivers and nonreceivers of interdisciplinary cognitive-behavioral group therapy. METHODS: We conducted semistructured interviews with 10 patients; 5 receiving cognitive-behavioral therapy in connection with their lumbar spinal fusion surgery and 5 receiving usual care. We conducted a phenomenological analysis to reach our first aim and then conducted a comparative content analysis to reach our second aim. RESULTS: Patients' postoperative experience was characterized by the need to adapt to the limitations imposed by back discomfort (coexisting with the back), need for recognition and support from others regarding their pain, a relatively long rehabilitation period during which they “awaited the result of surgery”, and ambivalence toward analgesics. The patients in both groups had similar negative perception of analgesics and tended to abstain from them to avoid addiction. Coping behavior apparently differed among receivers and nonreceivers of interdisciplinary cognitive-behavioral group therapy. Receivers prevented or minimized pain by resting before pain onset, whereas nonreceivers awaited pain onset before resting. CONCLUSION: The postoperative experience entailed ambivalence, causing uncertainty, worry and insecurity. This ambivalence was relieved when others recognized the patient's pain and offered support. Cognitive-behavioral therapy as part of

  2. In the quest for degenerative lumbar spinal stenosis etiology: the Schmorl's nodes model.

    PubMed

    Abbas, Janan; Slon, Viviane; Stein, Dan; Peled, Natan; Hershkovitz, Israel; Hamoud, Kamal

    2017-04-20

    Degenerative lumbar spinal stenosis (DLSS) is a common health problem in the elderly and usually associated with three-joint complex degeneration. Schmorl's nodes (SNs) are described as vertical herniation of the disc into the vertebral body through a weakened part of the end plate that can lead to disc degeneration. Since SNs can harm the spine unit stability, the association between DLSS and SNs is expected. The aim of this study is to shed light on the relationship between degenerative lumbar spinal stenosis and SNs. Two groups of individuals were studied: the first included 165 individuals with DLSS (age range: 40-88, sex ratio: 80 M/85 F) and the second 180 individuals without spinal stenosis related symptoms (age range: 40-99, sex ratio: 90 M/90 F). The presence or absence of SNs on the cranial and caudal end plate surfaces at the lumbosacral region (from L1 to S1 vertebra) was recorded, using CT images (Brilliance 64 Philips Medical System, Cleveland Ohio, thickness of the sections was 1-3 mm and MAS, 80-250). Chi-Square test was taken to compare the prevalence of SNs between the study groups (control and stenosis) by lumbar disc level, for each gender separately. Multivariable logistic regression analysis was also used to determine the association between DLSS and SNs. The prevalence rate of SNs was significantly greater in the stenosis males (L1-2 to L5-S1) and females (L4-5 and L4-S1) compared to their counterparts in the control (P < 0.001). In addition, the presence of SNs in both males and females was found to increase the likelihood for DLSS. Our results indicate that SNs prevalence is significantly greater in the DLSS group compared to the control. Furthermore, SNs are strongly associated with DLSS.

  3. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions

    PubMed Central

    Manchikanti, Laxmaiah; Boswell, Mark V; Singh, Vijay; Pampati, Vidyasagar; Damron, Kim S; Beyer, Carla D

    2004-01-01

    Background Facet joints are a clinically important source of chronic cervical, thoracic, and lumbar spine pain. The purpose of this study was to systematically evaluate the prevalence of facet joint pain by spinal region in patients with chronic spine pain referred to an interventional pain management practice. Methods Five hundred consecutive patients with chronic, non-specific spine pain were evaluated. The prevalence of facet joint pain was determined using controlled comparative local anesthetic blocks (1% lidocaine or 1% lidocaine followed by 0.25% bupivacaine), in accordance with the criteria established by the International Association for the Study of Pain (IASP). The study was performed in the United States in a non-university based ambulatory interventional pain management setting. Results The prevalence of facet joint pain in patients with chronic cervical spine pain was 55% 5(95% CI, 49% – 61%), with thoracic spine pain was 42% (95% CI, 30% – 53%), and in with lumbar spine pain was 31% (95% CI, 27% – 36%). The false-positive rate with single blocks with lidocaine was 63% (95% CI, 54% – 72%) in the cervical spine, 55% (95% CI, 39% – 78%) in the thoracic spine, and 27% (95% CI, 22% – 32%) in the lumbar spine. Conclusion This study demonstrated that in an interventional pain management setting, facet joints are clinically important spinal pain generators in a significant proportion of patients with chronic spinal pain. Because these patients typically have failed conservative management, including physical therapy, chiropractic treatment and analgesics, they may benefit from specific interventions designed to manage facet joint pain. PMID:15169547

  4. Problem areas identified as important to older adults with lumbar spinal stenosis.

    PubMed

    Edwards, Todd C; Lavallee, Danielle C; Bauer, Zoya; Comstock, Bryan A; Jarvik, Jeffrey G; Patrick, Donald L; Makris, Una E; Friedly, Janna L

    2015-07-01

    There is growing concern that patient-reported outcomes (PROs) commonly used in clinical research evaluating treatments such as epidural steroid injections (ESIs) for lumbar spinal stenosis may not adequately capture outcomes of greatest importance to older adults. The purpose of the study was to determine what outcomes are most important to older adults with spinal stenosis, how well commonly used PROs reflect what is most important to these participants, and which outcomes older adults with spinal stenosis would want improved to consider having ESI. This is an outcome prioritization study. Community sample of 33 older adults with spinal stenosis were included. The outcome measures were Swiss Spinal Stenosis Questionnaire and Roland-Morris Disability Questionnaire. The methods involve individual sorting and ranking exercises followed by facilitated focus groups. Highest rated problem areas were "experiencing pain/discomfort" (88% of participants), "problems with physical function" (85%), "difficulty exercising" (73%), "difficulty participating in hobbies and leisure activities" (55%), and "problems with weakness" (52%). Only 10 of the 24 Roland-Morris Disability Questionnaire items were rated by 50% or more of participants experiencing them as important enough to warrant ESI treatment. Older adults with spinal stenosis rated problems related to pain and physical function as the most important outcomes to them. However, difficulty exercising and difficulty participating in hobbies and leisure activities were also among the most highly rated and were two areas not typically assessed in treatment studies. Commonly used PROs in spinal stenosis treatment studies may be insufficient to comprehensively assess outcomes from the patient perspective. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. ABDOMINAL MUSCLE ACTIVATION INCREASES LUMBAR SPINAL STABILITY: ANALYSIS OF CONTRIBUTIONS OF DIFFERENT MUSCLE GROUPS

    PubMed Central

    Stokes, Ian A.F.; Gardner-Morse, Mack G.; Henry, Sharon M.

    2011-01-01

    Background Antagonistic activation of abdominal muscles and raised intra-abdominal pressure are associated with both spinal unloading and spinal stabilization. Rehabilitation regimens have been proposed to improve spinal stability via selective recruitment of certain trunk muscle groups. This biomechanical study used an analytical model to address whether lumbar spinal stability is increased by selective activation of abdominal muscles. Methods The biomechanical model included anatomically realistic three-layers of curved abdominal musculature connected by fascia, rectus abdominis and 77 symmetrical pairs of dorsal muscles. The muscle activations were calculated with the model loaded with either flexion, extension, lateral bending or axial rotation moments up to 60 Nm, along with intra-abdominal pressure up to 5 or 10 kPa (37.5 or 75 mm Hg) and partial bodyweight. After solving for muscle forces, a buckling analysis quantified spinal stability. Subsequently, different patterns of muscle activation were studied by forcing activation of selected abdominal muscles to at least 10% or 20% of maximum. Findings The spinal stability increased by an average factor of 1.8 with doubling of intra-abdominal pressure. Forced activation of obliques or transversus abdominis muscles to at least 10% of maximum increased stability slightly for efforts other than flexion, but forcing at least 20% activation generally did not produce further increase in stability. Forced activation of rectus abdominis did not increase stability. Interpretation Based on predictions from an analytical spinal buckling model, the degree of stability was not substantially influenced by selective forcing of muscle activation. This casts doubt on the supposed mechanism of action of specific abdominal muscle exercise regimens that have been proposed for low back pain rehabilitation. PMID:21571410

  6. Reducing surgical levels by paraspinal mapping and diffusion tensor imaging techniques in lumbar spinal stenosis.

    PubMed

    Chen, Hua-Biao; Wan, Qi; Xu, Qi-Feng; Chen, Yi; Bai, Bo

    2016-04-25

    Correlating symptoms and physical examination findings with surgical levels based on common imaging results is not reliable. In patients who have no concordance between radiological and clinical symptoms, the surgical levels determined by conventional magnetic resonance imaging (MRI) and neurogenic examination (NE) may lead to a more extensive surgery and significant complications. We aimed to confirm that whether the use of diffusion tensor imaging (DTI) and paraspinal mapping (PM) techniques can further prevent the occurrence of false positives with conventional MRI, distinguish which are clinically relevant from levels of cauda equina and/or nerve root lesions based on MRI, and determine and reduce the decompression levels of lumbar spinal stenosis than MRI + NE, while ensuring or improving surgical outcomes. We compared the data between patients who underwent MRI + (PM or DTI) and patients who underwent conventional MRI + NE to determine levels of decompression for the treatment of lumbar spinal stenosis. Outcome measures were assessed at 2 weeks, 3 months, 6 months, and 12 months postoperatively. One hundred fourteen patients (59 in the control group, 54 in the experimental group) underwent decompression. The levels of decompression determined by MRI + (PM or DTI) in the experimental group were significantly less than that determined by MRI + NE in the control group (p = 0.000). The surgical time, blood loss, and surgical transfusion were significantly less in the experimental group (p = 0.001, p = 0.011, p = 0.001, respectively). There were no differences in improvement of the visual analog scale back and leg pain (VAS-BP, VAS-LP) scores and Oswestry Disability Index (ODI) scores at 2 weeks, 3 months, 6 months, and 12 months after operation between the experimental and control groups. MRI + (PM or DTI) showed clear benefits in determining decompression levels of lumbar spinal stenosis than MRI + NE. In patients with lumbar spinal

  7. The narrowing of the lumbar spinal canal during loaded MRI: the effects of the disc and ligamentum flavum.

    PubMed

    Hansson, Tommy; Suzuki, Nobuyuki; Hebelka, Hanna; Gaulitz, Arne

    2009-05-01

    Load and activity changes of the spine typically cause symptoms of nerve root compression in subjects with spinal stenosis. Protrusion of the intervertebral disc has been regarded as the main cause of the compression. The objective was to determine the changes in the size of the lumbar spinal canal and especially those caused by the ligamentum flavum and the disc during loaded MRI. For this purpose an interventional clinical study on consecutive patients was made. The lumbar spines in 24 supine patients were examined with MRI: first without any external load and then with an axial load corresponding to half the body weight. The effect of the load was determined through the cross-sectional areas of the spinal canal and the ligamentum flavum, the thickness of ligamentum flavum, the posterior bulge of the disc and the intervertebral angle. External load decreased the size of the spinal canal. Bulging of the ligamentum flavum contributed to between 50 and 85% of the spinal canal narrowing. It was concluded that the ligamentum flavum, not the disc had a dominating role for the load induced narrowing of the lumbar spinal canal, a finding that can improve the understanding of the patho-physiology in spinal stenosis.

  8. Iliac Crest Bone Graft versus Local Autograft or Allograft for Lumbar Spinal Fusion: A Systematic Review

    PubMed Central

    Tuchman, Alexander; Brodke, Darrel S.; Youssef, Jim A.; Meisel, Hans-Jörg; Dettori, Joseph R.; Park, Jong-Beom; Yoon, S. Tim; Wang, Jeffrey C.

    2016-01-01

    Study Design  Systematic review. Objective  To compare the effectiveness and safety between iliac crest bone graft (ICBG) and local autologous bone and allograft in the lumbar spine. Methods  A systematic search of multiple major medical reference databases identified studies evaluating spinal fusion in patients with degenerative joint disease using ICBG, local autograft, or allograft in the thoracolumbar spine. Results  Six comparative studies met our inclusion criteria. A “low” strength of the overall body of evidence suggested no difference in fusion percentages in the lumbar spine between local autograft and ICBG. We found no difference in fusion percentages based on low evidence comparing allograft with ICBG autograft. There were no differences in pain or functional results comparing local autograft or allograft with ICBG autograft. Donor site pain and hematoma/seroma occurred more frequently in ICBG autograft group for lumbar fusion procedures. There was low evidence around the estimate of patients with donor site pain following ICBG harvesting, ranging from 16.7 to 20%. With respect to revision, low evidence demonstrated no difference between allograft and ICBG autograft. There was no evidence comparing patients receiving allograft with local autograft for fusion, pain, functional, and safety outcomes. Conclusion  In the lumbar spine, ICBG, local autograft, and allograft have similar effectiveness in terms of fusion rates, pain scores, and functional outcomes. However, ICBG is associated with an increased risk for donor site-related complications. Significant limitations exist in the available literature when comparing ICBG, local autograft, and allograft for lumbar fusion, and thus ICBG versus other fusion methods necessitates further investigation. PMID:27556001

  9. Adult-onset intradural spinal teratoma in the lumbar spine: A case report.

    PubMed

    Arai, Yasuhisa; Takahashi, Masaki; Takeda, Koutarou; Shitoto, Katsuo

    2000-12-01

    Intradural spinal teratoma is a very rare tumour that can be associated with dysraphic defects. We report a case of adult-onset intradural spinal teratoma in the lumbar spine. The patient was a 54-year-old female who had chief complaints of a gait disturbance. X-rays showed an enlargement of the interpedicular distance at L3/L4 and spina bifida distal to L4. MRI showed a spindle-shaped tumour between L2 and L5. We performed laminotomy using an ultrasonic surgical knife. Pathological diagnosis of the resected tumour was matured teratoma. The diagnosis of matured teratoma was made because the tumour had no epithelium and a layered structure including prostate tissue, matured fat, cartilage and sweat gland.

  10. Changes in the Expressions of Iba1 and Calcitonin Gene-Related Peptide in Adjacent Lumbar Spinal Segments after Lumbar Disc Herniation in a Rat Model

    PubMed Central

    2015-01-01

    Lumbar disc herniation is commonly encountered in clinical practice and can induce sciatica due to mechanical and/or chemical irritation and the release of proinflammatory cytokines. However, symptoms are not confined to the affected spinal cord segment. The purpose of this study was to determine whether multisegmental molecular changes exist between adjacent lumbar spinal segments using a rat model of lumbar disc herniation. Twenty-nine male Sprague-Dawley rats were randomly assigned to either a sham-operated group (n=10) or a nucleus pulposus (NP)-exposed group (n=19). Rats in the NP-exposed group were further subdivided into a significant pain subgroup (n=12) and a no significant pain subgroup (n=7) using mechanical pain thresholds determined von Frey filaments. Immunohistochemical stainings of microglia (ionized calcium-binding adapter molecule 1; Iba1), astrocytes (glial fibrillary acidic protein; GFAP), calcitonin gene-related peptide (CGRP), and transient receptor potential vanilloid 1 (TRPV1) was performed in spinal dorsal horns and dorsal root ganglions (DRGs) at 10 days after surgery. It was found immunoreactivity for Iba1-positive microglia was higher in the L5 (P=0.004) dorsal horn and in the ipsilateral L4 (P=0.009), L6 (P=0.002), and S1 (P=0.002) dorsal horns in the NP-exposed group than in the sham-operated group. The expression of CGRP was also significantly higher in ipsilateral L3, L4, L6, and S1 segments and in L5 DRGs at 10 days after surgery in the NP-exposed group than in the sham-operated group (P<0.001). Our results indicate that lumbar disc herniation upregulates microglial activity and CGRP expression in many adjacent and ipsilateral lumbar spinal segments. PMID:26713069

  11. Changes in the Expressions of Iba1 and Calcitonin Gene-Related Peptide in Adjacent Lumbar Spinal Segments after Lumbar Disc Herniation in a Rat Model.

    PubMed

    Cho, Hee Kyung; Ahn, Sang Ho; Kim, So-Yeon; Choi, Mi-Jung; Hwang, Se Jin; Cho, Yun Woo

    2015-12-01

    Lumbar disc herniation is commonly encountered in clinical practice and can induce sciatica due to mechanical and/or chemical irritation and the release of proinflammatory cytokines. However, symptoms are not confined to the affected spinal cord segment. The purpose of this study was to determine whether multisegmental molecular changes exist between adjacent lumbar spinal segments using a rat model of lumbar disc herniation. Twenty-nine male Sprague-Dawley rats were randomly assigned to either a sham-operated group (n=10) or a nucleus pulposus (NP)-exposed group (n=19). Rats in the NP-exposed group were further subdivided into a significant pain subgroup (n=12) and a no significant pain subgroup (n=7) using mechanical pain thresholds determined von Frey filaments. Immunohistochemical stainings of microglia (ionized calcium-binding adapter molecule 1; Iba1), astrocytes (glial fibrillary acidic protein; GFAP), calcitonin gene-related peptide (CGRP), and transient receptor potential vanilloid 1 (TRPV1) was performed in spinal dorsal horns and dorsal root ganglions (DRGs) at 10 days after surgery. It was found immunoreactivity for Iba1-positive microglia was higher in the L5 (P=0.004) dorsal horn and in the ipsilateral L4 (P=0.009), L6 (P=0.002), and S1 (P=0.002) dorsal horns in the NP-exposed group than in the sham-operated group. The expression of CGRP was also significantly higher in ipsilateral L3, L4, L6, and S1 segments and in L5 DRGs at 10 days after surgery in the NP-exposed group than in the sham-operated group (P<0.001). Our results indicate that lumbar disc herniation upregulates microglial activity and CGRP expression in many adjacent and ipsilateral lumbar spinal segments.

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

    PubMed

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

    2013-12-01

    As spinal surgery in elderly patients is becoming increasingly frequent, comorbidities likely to be decompensated after such procedures must be kept in mind. We report here the case of an 82-year-old woman who presented rapidly progressive spinal cord compression following lumbar surgery for radiculopathy. Investigations showed a thoracic intradural extramedullary compressive lesion, which after removal turned out to be a meningioma. We suggest that radiculopathy and non-specific degenerative modifications partially masked this lesion, and that lumbar surgery caused this acute neurological deterioration. Therefore, we advice caution in older patients among whom such ambiguous clinical presentation is frequent. Copyright © 2013. Published by Elsevier Masson SAS.

  13. Post-surgical functional recovery, lumbar lordosis, and range of motion associated with MR-detectable redundant nerve roots in lumbar spinal stenosis.

    PubMed

    Chen, Jinshui; Wang, Juying; Wang, Benhai; Xu, Hao; Lin, Songqing; Zhang, Huihao

    2016-01-01

    T1- and T2-weighted magnetic resonance images (MRI) can reveal lumbar redundant nerve roots (RNRs), a result of chronic compression and nerve elongation associated with pathogenesis of cauda equina claudication (CEC) in degenerative lumbar canal stenosis (DLCS). The study investigated effects of lumbar lordosis angle and range of motion on functional recovery in lumbar stenosis patents with and without RNRs. A retrospective study was conducted of 93 lumbar spinal stenosis patients who underwent decompressive surgery. Eligible records were assessed by 3 independent blinded radiologists for presence or absence of RNRs on sagittal T2-weighted MR (RNR and non-RNR groups), pre- and post-operative JOA score, lumbar lordosis angle, and range of motion. Of 93 total patients, the RNR group (n=37, 21/37 female) and non-RNR group (n=56; 31/56 female) had similar preoperative conditions (JOA score) and were not significantly different in age (mean 64.19 ± 8.25 vs. 62.8 ± 9.41 years), symptom duration (30.92 ± 22.43 vs. 28.64 ± 17.40 months), or follow-up periods (17.35 ± 4.02 vs. 17.75 ± 4.29 mo) (all p>0.4). The non-RNR group exhibited significantly better final JOA score (p=0.015) and recovery rate (p=0.002). RNR group patients exhibited larger lumbar lordosis angles in the neutral position (p=0.009) and extension (p=0.021) and larger range of motion (p=0.008). Poorer surgical outcomes in patients with RNRs indicated that elevated lumbar lordosis angle and range of motion increased risks of RNR formation, which in turn may cause poorer post-surgical recovery, this information is possibly useful in prognostic assessment of lumbar stenosis complicated by RNRs. Copyright © 2015 Elsevier B.V. All rights reserved.

  14. Lumbar extraforaminal entrapment: performance characteristics of detecting the foraminal spinal angle using oblique coronal MRI. A multicenter study.

    PubMed

    Takeuchi, Mikinobu; Wakao, Norimitsu; Kamiya, Mitsuhiro; Hirasawa, Atsuhiko; Osuka, Koji; Joko, Masahiro; Kawanami, Katsuhisa; Takayasu, Masakazu

    2015-05-01

    Previous conventional magnetic resonance imaging reports on extraforaminal entrapment (e-FE) on L5-S1 have been problematic because of their complexity or lack of sensitivity and specificity. In this study, we propose a simple diagnostic method for e-FE. The purpose of this study was to determine the sensitivity and specificity of using the difference in the foraminal spinal nerve (FSN) angle of the L5 nerve, as determined by oblique coronal T2-weighted imaging (OC-T2WI), for diagnosing L5-S1 unilateral e-FE. The study design involves diagnostic accuracy with retrospective case-control study. Seventy consecutive patients with unilateral L5 radiculopathy who underwent unilateral L5-S1 extraspinal canal decompression for e-FE or 4/5 intraspinal canal decompression for lumbar spinal canal stenosis between 2009 and 2013 were included. The Japanese Orthopedic Association score, Visual Analog Scale score for leg pain, and OC-T2WI for the FSN angle of the L5 nerve were examined. The 70 patients were divided into two groups: Group A (n=21) with unilateral L5-S1 e-FE and Group B (n=49) with intraspinal canal L4-L5. Group C (n=44) comprised the control group, which included only patients with back pain without leg radiculopathy. All patients underwent OC-T2WI, and the differences in the FSN angle of the fifth lumbar spinal nerve between the symptomatic and asymptomatic sides (ΔFSN angle) were examined and compared among the groups. There were no significant differences in the patient characteristics among the three groups. The ΔFSN angle was 17° in Group A, 4.8° in Group B, and 6.4° in Group C, and the laterality was significantly larger in Group A than in the other two groups. A receiver-operating characteristic curve showed areas under the curve between groups A and B and between groups A and C of 0.93 and 0.97, respectively. In addition, the cutoff value of the ΔFSN angle (10°) indicated diagnostic accuracies of 94% and 91% (sensitivity and specificity) and of 93

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

    PubMed Central

    Yousef, Gamal T.; Lasheen, Ahmed E.

    2012-01-01

    Background: Laparoscopic cholecystectomy became the standard surgery for gallstone disease because of causing less postoperative pain, respiratory compromise and early ambulation. Objective: This study was designed to compare spinal anesthesia, (segmental thoracic or conventional lumbar) vs the gold standard general anesthesia as three anesthetic techniques for healthy patients scheduled for elective laparoscopic cholecystectomy, evaluating intraoperative parameters, postoperative recovery and analgesia, complications as well as patient and surgeon satisfaction. Materials and Methods: A total of 90 patients undergoing elective laparoscopic cholecystectomy, between January 2010 and May 2011, were randomized into three equal groups to undergo laparoscopic cholecystectomy with low-pressure CO2 pneumoperitoneum under segmental thoracic (TSA group) or conventional lumbar (LSA group) spinal anesthesia or general anesthesia (GA group). To achieve a T3 sensory level we used (hyperbaric bupivacaine 15 mg, and fentanyl 25 mg at L2/L3) for LSAgroup, and (hyperbaric bupivacaine 7.5 mg, and fentanyl 25 mg at T10/T11) for TSAgroup. Propofol, fentanyl, atracurium, sevoflurane, and tracheal intubation were used for GA group. Intraoperative parameters, postoperative recovery and analgesia, complications as well as patient and surgeon satisfaction were compared between the three groups. Results: All procedures were completed laparoscopically by the allocated method of anesthesia with no anesthetic conversions. The time for the blockade to reach T3 level, intraoperative hypotensive and bradycardic events and vasopressor use were significantly lower in (TSA group) than in (LSA group). Postoperative pain scores as assessed throughout any time, postoperative right shoulder pain and hospital stay was lower for both (TSA group) and (LSA group) compared with (GA group). The higher degree of patients satisfaction scores were recorded in patients under segmental TSA. Conclusion: The present

  16. Lumbar scoliosis associated with spinal stenosis in idiopathic and degenerative cases.

    PubMed

    Le Huec, J C; Cogniet, A; Mazas, S; Faundez, A

    2016-10-01

    Degenerative de novo scoliosis is commonly present in older adult patients. The degenerative process including disc bulging, facet arthritis, and ligamentum flavum hypertrophy contributes to the appearance of symptoms of spinal stenosis. Idiopathic scoliosis has also degenerative changes that can lead to spinal stenosis. The aetiology, prevalence, biomechanics, classification, symptomatology, and treatment of idiopathic and degenerative lumbar scoliosis in association with spinal stenosis are reviewed. Review study is based on a review of pertinent but non-exhaustive literature of the last 20 years in PubMed in English language. Retrospective analysis of studies focused on all parameters concerning scoliosis associated with stenosis. Very few publications have focused specifically on idiopathic scoliosis and stenosis, and this was before the advent of modern segmental instrumentation. On the other hand, many papers were found for degenerative scoliosis and stenosis with treatment methods based on aetiology of spinal canal stenosis and analysis of global sagittal and frontal parameters. Satisfactory clinical results after operative treatment range from 83 to 96 % but with increased percentage of complications. Recent literature analysed the importance of stabilizing or not the spine after decompression in such situation knowing the increasing risk of instability after facet resection. No prospective randomized studies were found to support short instrumentation. Long instrumentation and fusion to prevent distabilization after decompression were always associated with higher complication rates. Imbalance patients with unsatisfactory compensation capacities were at risk of complications. Operative treatment using newly proposed classification system of lumbar scoliosis with associated canal stenosis is useful. Sagittal balance and rotatory dislocation are the main parameters to analyse to determine the length of fusion.

  17. Multiple-hook fixation in revision spinal deformity surgery for patients with a previous multilevel fusion mass: technical note and preliminary outcomes.

    PubMed

    Liu, Ning; Wood, Kirkham B

    2017-03-01

    OBJECTIVE A previous multilevel fusion mass encountered during revision spinal deformity surgery may obscure anatomical landmarks, making instrumentation unworkable or incurring substantial blood loss and operative time. This study introduced a surgical technique of multiple-hook fixation for fixating previous multilevel fusion masses in revision spinal deformity surgeries and then evaluated its outcomes. METHODS Patients with a previous multilevel fusion mass who underwent revision corrective surgery down to the lumbosacral junction were retrospectively studied. Multiple hooks were used to fixate the fusion mass and linked to distal pedicle screws in the lumbosacral-pelvic complex. Radiological and clinical outcomes were evaluated. RESULTS The charts of 8 consecutive patients with spinal deformity were retrospectively reviewed (7 women, 1 man; mean age 56 years). The primary diagnoses included flat-back deformity (6 cases), thoracolumbar kyphoscoliosis (1 case), and lumbar spondylosis secondary to a previous scoliosis fusion (1 case). The mean follow-up duration was 30.1 months. Operations were performed at T3/4-ilium (4 cases), T7-ilium (1 case), T6-S1 (1 case), T12-S1 (1 case), and T9-L5 (1 case). Of 8 patients, 7 had sagittal imbalance preoperatively, and their mean C-7 plumb line improved from 10.8 ± 2.9 cm preoperatively to 5.3 ± 3.6 cm at final follow-up (p = 0.003). The mean lumbar lordosis of these patients at final follow-up was significantly greater than that preoperatively (35.2° ± 12.6° vs 16.8° ± 11.8°, respectively; p = 0.005). Two perioperative complications included osteotomy-related leg weakness in 1 patient and a stitch abscess in another. CONCLUSIONS The multiple-hook technique provides a viable alternative option for fixating a previous multilevel fusion mass in revision spinal deformity surgery.

  18. Assessment of spinal movement reduction by thoraco-lumbar-sacral orthoses.

    PubMed

    van Leeuwen, P J; Bos, R P; Derksen, J C; de Vries, J

    2000-01-01

    Bracing is a common modality in treating spinal fractures. Its objective is to reduce spinal movements and to stabilize the fracture. Until now, factual insight into the movement-reducing properties of Thoraco-Lumbar-Sacral Orthoses (TLSOs) has been missing. Two common TLSOs (e.g., Jewett and Voigt-Bähler) were tested for their movement-reducing properties in two small groups of healthy subjects. In the first study, maximal gross spinal movements, with and without a TLSO, were measured by means of a Portable Posture Registration Set (PPRS) in three different planes. In the second study, maximal segmental vertebral movements in the regions T10 to L4 were measured via X-rays. With few notable exceptions, wearing a TLSO, as measured by the PPRS and X-ray techniques, significantly reduced the segmental as well as gross spinal movements. However, the amount of movement reduction varied greatly from subject-to-subject and was sometimes small. Unfortunately, data are lacking on the amount of movement reduction that is clinically relevant.

  19. A new lumbar posterior fixation system, the memory metal spinal system: an in-vitro mechanical evaluation

    PubMed Central

    2013-01-01

    Background Spinal systems that are currently available for correction of spinal deformities or degeneration such as lumbar spondylolisthesis or degenerative disc disease use components manufactured from stainless steel or titanium and typically comprise two spinal rods with associated connection devices (for example: DePuy Spines Titanium Moss Miami Spinal System). The Memory Metal Spinal System of this study consists of a single square spinal rod made of a nickel titanium alloy (Nitinol) used in conjunction with connecting transverse bridges and pedicle screws made of Ti-alloy. Nitinol is best known for its shape memory effect, but is also characterized by its higher flexibility when compared to either stainless steel or titanium. A higher fusion rate with less degeneration of adjacent segments may result because of the elastic properties of the memory metal. In addition, the use of a single, unilateral rod may be of great value for a TLIF procedure. Our objective is to evaluate the mechanical properties of the new Memory Metal Spinal System compared to the Titanium Moss Miami Spinal System. Methods An in-vitro mechanical evaluation of the lumbar Memory Metal Spinal System was conducted. The test protocol followed ASTM Standard F1717-96, “Standard Test Methods for Static and Fatigue for Spinal Implant Constructs in a Corpectomy Model.” 1. Static axial testing in a load to failure mode in compression bending, 2. Static testing in a load to failure mode in torsion, 3. Cyclical testing to estimate the maximum run out load value at 5.0 x 10^6 cycles. Results In the biomechanical testing for static axial compression bending there was no statistical difference between the 2% yield strength and the stiffness of the two types of spinal constructs. In axial compression bending fatigue testing, the Memory Metal Spinal System construct showed a 50% increase in fatigue life compared to the Titanium Moss Miami Spinal System. In static torsional testing the Memory Metal

  20. A new lumbar posterior fixation system, the memory metal spinal system: an in-vitro mechanical evaluation.

    PubMed

    Kok, Dennis; Firkins, Paul John; Wapstra, Frits H; Veldhuizen, Albert G

    2013-09-18

    Spinal systems that are currently available for correction of spinal deformities or degeneration such as lumbar spondylolisthesis or degenerative disc disease use components manufactured from stainless steel or titanium and typically comprise two spinal rods with associated connection devices (for example: DePuy Spines Titanium Moss Miami Spinal System). The Memory Metal Spinal System of this study consists of a single square spinal rod made of a nickel titanium alloy (Nitinol) used in conjunction with connecting transverse bridges and pedicle screws made of Ti-alloy. Nitinol is best known for its shape memory effect, but is also characterized by its higher flexibility when compared to either stainless steel or titanium. A higher fusion rate with less degeneration of adjacent segments may result because of the elastic properties of the memory metal. In addition, the use of a single, unilateral rod may be of great value for a TLIF procedure. Our objective is to evaluate the mechanical properties of the new Memory Metal Spinal System compared to the Titanium Moss Miami Spinal System. An in-vitro mechanical evaluation of the lumbar Memory Metal Spinal System was conducted. The test protocol followed ASTM Standard F1717-96, "Standard Test Methods for Static and Fatigue for Spinal Implant Constructs in a Corpectomy Model." 1. Static axial testing in a load to failure mode in compression bending, 2. Static testing in a load to failure mode in torsion, 3. Cyclical testing to estimate the maximum run out load value at 5.0 x 10^6 cycles. In the biomechanical testing for static axial compression bending there was no statistical difference between the 2% yield strength and the stiffness of the two types of spinal constructs. In axial compression bending fatigue testing, the Memory Metal Spinal System construct showed a 50% increase in fatigue life compared to the Titanium Moss Miami Spinal System. In static torsional testing the Memory Metal Spinal System constructs showed an

  1. Effect of Adding Calcitonin to Translaminar Epidural Steroid in Degenerative Lumbar Spinal Canal Stenosis.

    PubMed

    Elsheikh, Nabil Ail; Amr, Yasser M

    2016-03-01

    Spinal canal stenosis is one of the most common causes of low back pain and disability. Its management varies from surgical to conservative, and the indications for ideal management are not clearly defined. This study was conducted to evaluate the effect of adding calcitonin to local anesthetic and corticosteroid in epidural injection for patients suffering from degenerative lumbar spinal canal stenosis. Randomized double-blind clinical trial. Hospital outpatient setting. One hundred thirty-two patients with degenerative spinal canal stenosis were randomly allocated into 2 groups. Group I received C-arm guided epidural injection of local anesthetic and corticosteroid and Group II received 50 international unit calcitonin added to the mixture of local anesthetic and corticosteroid. Both groups received 2 sets of injections, one week apart. Visual analogue scale for pain during movement and walking distance until incidence of neurogenic claudication have been used for pain assessment, and Oswestry Low Back Pain Disability Questionnaire and analgesic consumption were evaluated for one year. Both groups showed comparable benefits regarding improvement in pain intensity, walking distance, Oswestry scale, and analgesic consumption during the first month follow-up period. These beneficial effects continued in calcitonin group for one year. The present study patients would be graded as having mild or at worst moderate stenosis. So, the present study did not examine the efficacy of epidural calcitonin in severe spinal canal stenosis and did not stratify the results according to degree of stenosis which would also have been useful in determining the validity of calcitonin in different degrees of stenosis. Adding calcitonin to epidural steroid and local anesthetic injection seems to be more effective than epidural steroid and local anesthesia alone in management of spinal canal stenosis regarding increased walking distance, better Oswestry scale, diminished pain intensity and

  2. Clinical outcome of lumbar spinal stenosis based on new classification according to hypertrophied ligamentum flavum.

    PubMed

    Sakai, Yoshihito; Ito, Sadayuki; Hida, Tetsuro; Ito, Kenyu; Harada, Atsushi; Watanabe, Ken

    2017-01-01

    The ligamentum flavum hypertrophy is considered to be one of the important causes of development of lumbar spinal stenosis (LSS). Several histologic and biologic mechanisms in hypertrophied flavum have proposed. However, no study that investigated the relationship between clinical outcome and ligamentum flavum hypertrophy has been published. The purpose of this study was to identify a new classification of LSS, in ligamentous and nonligamentous stenosis, according to the cutoff value of the area proportion of the ligamentum flavum in the spinal canal, and to assess the value of surgical and conservative treatments for LSS based on the classification of the ligamentous stenosis. A total of 230 surgical patients with LSS were evaluated based on the cross-sectional area and intraoperative findings of the ligamentum flavum. LSS was classified as ligamentous or nonligamentous stenosis, according to the cutoff value of the proportion of the ligamentum flavum in the spinal canal. Based on the classification, the results of 234 surgical patients (103 patients with spinal fusion surgery and 131 patients with spinal decompression) and 191 patients under conservative treatment with prostaglandin E1 were evaluated, 1 year after treatments. ROC analysis revealed that the area under the curve for the cutoff value of the proportion of the ligamentum flavum in the spinal canal was 0.4275 (sensitivity = 0.861, specificity = 0.854). Based on these criteria, ligamentous and nonligamentous stenoses were 115 and 119 in surgical patients, 97 and 94 in conservative patients, respectively. In the surgical treatment group, no significant difference was found in any of the evaluations conducted for the group with ligamentous and nonligamentous stenosis. However, in the conservative treatment group, the patients with ligamentous stenosis showed significant improvement compared with patients with nonligamentous stenosis. Ligamentous stenosis in LSS patients had favorable outcome on

  3. Percutaneous surgical treatment in lumbar spinal stenosis with Aperius-PercLID: indications, surgical technique and results.

    PubMed

    Menchetti, P P M; Postacchini, F; Bini, W; Canero, G

    2011-01-01

    Interspinous spacers have recently been used in the treatment of lumbar spinal stenosis. In vitro studies have demonstrated a reduction in facet joint forces by 68% and annulus pressures by 63%. MRI studies have demonstrated increased canal and neural foraminal area after implantation of these devices. Previous studies by Zucherman et al. (Spine 30:1351-1358, 2005) demonstrated patient satisfaction rates of 71-73%.We carried out a multicentric retrospective study to assess the clinical outcomes following percutaneous posterior decompression using an interspinous spacer device (Aperius™-PercLID™ System; Kyphon-Medtronic). A total of 70 patients were included in the study. All of them had evidence of radiologically and clinically proven lumbar stenosis. The average age was 63.5 years. Patients completed the Zurich Claudication Questionnaire (ZCQ) and recorded pain levels on a Visual Analogue Scale (VAS). Average stay in hospital was 2 days. The average improvement in ZCQ included both symptomatic pain disappearance and functional ambulatory recovery. The average VAS pain score improved from 8.2 to 3.6 (scale of 1 to 10). The overall patient satisfaction rate was 76%. No complications were detected at 6 months' follow-up.

  4. Surgical treatment for lumbar hyperlordosis after resection of a spinal lipoma associated with spina bifida: A case report.

    PubMed

    Sato, Tatsuya; Yonezawa, Ikuho; Onda, Shingo; Yoshikawa, Kei; Takano, Hiromitsu; Shimamura, Yukitoshi; Okuda, Takatoshi; Kaneko, Kazuo

    2017-09-01

    A hyperlordosis deformity of the lumbar spine is relatively rare, and surgical treatment has not been comprehensively addressed. In this case report, we describe the clinical presentation, surgical treatment, and medium-term follow-up of a patient presenting with a progressive lumbar hyperlordosis deformity after resection of a spinal lipoma associated with spina bifida. The patient was a 20-year-old woman presenting with a progressive hyperlordosis deformity of the lumbar spine associated with significant back pain (visual analog pain score of 89/100 mm), but with no neurological symptoms. The lumbar lordosis (LL), measured on standing lateral view radiographs, was 114°, with a sagittal vertical axis (SVA) of -100 mm. The patient had undergone excision of a lipoma, associated with spina bifida of the lumbar spine, at 7 months of age.She was first evaluated at our hospital at 18 years of age for progressive spinal deformity and lumbago. An in situ fusion, from T5 to S1, using pedicle screws with bone graft obtained from the iliac crest, was performed. Postoperatively, the LL decreased to 93°, and the SVA decreased to -50 mm. The decision to not correct the hyperlordosis deformity fully was intentional. Seven years and 1 month postsurgery, the patient had no limitations in standing and walking and reported a pain score of 8/100 mm; there was no evidence of a loss of correction. Lumbar hyperlordosis after resection of a spinal lipoma associated with spina bifida is rare. Posterior fixation provided an effective treatment in this case. As the lumbar hyperlordosis deformity is often high, correction can be difficult. In this case, although the correction and fusion were performed in situ, there was no progression of either the deformity or the lumbago. Early detection remains an essential component of effective treatment, allowing correction when the spinal deformity is easily reversible.

  5. A risk/benefit analysis of spinal manipulation therapy for relief of lumbar or cervical pain.

    PubMed

    Powell, F C; Hanigan, W C; Olivero, W C

    1993-07-01

    Approximately 12 million Americans undergo spinal manipulation therapy (SMT) every year. Renewed interest in this method requires an analysis of its reported risks and possible benefits. This review describes two patients with spinal cord injuries associated with SMT and establishes the risk/benefit ratios for patients with lumbar or cervical pain. The first case is a man who underwent SMT for recurrent sciatica 4 years after chemonucleolysis. During therapy, he developed bilateral sciatica with urinary hesitancy. After self-referral, myelography demonstrated a total block; he underwent urgent discectomy with an excellent result 3 months after surgery. The second patient with an indwelling Broviac catheter and a history of lumbar osteomyelitis underwent SMT for neck pain. Therapy continued for 3 weeks despite the development of severe quadriparesis. After self-referral, he underwent an urgent anterior cervical decompression and removal of necrotic bone and an epidural abscess with partial neurological recovery. An analysis of these cases and 138 cases reported in the literature demonstrates six risk factors associated with complications of SMT. These include misdiagnosis, failure to recognize the onset or progression of neurological signs or symptoms, improper technique, SMT performed in the presence of a coagulation disorder or herniated nucleus pulposus, and manipulation of the cervical spine. Clinical trials of SMT have been summarized in several recent articles.(ABSTRACT TRUNCATED AT 250 WORDS)

  6. Efficacy of exercise and ultrasound in patients with lumbar spinal stenosis: a prospective randomized controlled trial.

    PubMed

    Goren, Ahmet; Yildiz, Necmettin; Topuz, Oya; Findikoglu, Gulin; Ardic, Fusun

    2010-07-01

    To assess the effectiveness of therapeutic exercises alone and in combination with a single physical agent - ultrasound - in patients with lumbar spinal stenosis. Randomized, prospective, controlled trial. Department of Physical Medicine and Rehabilitation, University Hospital. Forty-five patients presenting with symptoms of neurological claudication and magnetic resonance image-proven lumbar spinal stenosis were assigned to one of three groups: ultrasound plus exercise group (group 1, n =15), sham ultrasound plus exercise group (group 2, n= 15) and no exercise - no treatment group (control group, n = 15). Stretching and strengthening exercises for lumbar, abdominal, leg muscles as well as low-intensity cycling exercises were given as therapeutic exercises. Ultrasound was applied with 1 mHz, 1.5 W/cm(2) intensity, in continuous mode on the back muscle for 10 minutes in group 1 while ultrasound on/off mode was applied in group 2. Before and after a three-week period, all subjects were evaluated by pain, disability, functional capacity and consumption of analgesic. Thirty-two of the participants were women and 13 were men, with an average age of 53.2 +/- 12.68 years (range 25-82 years). After a three-week treatment period, leg pain decreased in group 1 (-1.47 +/- 3.02) and group 2 (-2.47 +/- 3.75) compared with the control group (P<0.05). Disability score decreased in group 1 (-3.94 +/- 7.20) and group 2 (-7.80 +/- 10.26) compared with control group (P<0.05). We did not find any statistically significant difference between groups 1 and 2 (P>0.05). The amount of analgesic consumption is significantly less in the group with ultrasound application compared to that in the control group (P<0.05). The results of our study suggest that therapeutic exercises are effective for pain and disability in patients with lumbar spinal stenosis and that addition of ultrasound to exercise therapy lowers the analgesic intake substantially.

  7. Malnutrition Predicts Infectious and Wound Complications Following Posterior Lumbar Spinal Fusion.

    PubMed

    Bohl, Daniel D; Shen, Mary R; Mayo, Benjamin C; Massel, Dustin H; Long, William W; Modi, Krishna D; Basques, Bryce A; Singh, Kern

    2016-11-01

    A retrospective review of data collected prospectively by the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). The aim of this study was to investigate the association between preoperative hypoalbuminemia, a marker for malnutrition, and complications during the 30 days following posterior lumbar fusion surgery. Malnutrition is a potentially modifiable risk factor that may contribute to complications following spinal surgery. Although prior studies have identified associations between malnutrition, delayed wound healing, and surgical site infection (SSI), the evidence for such a relationship within spine surgery is mixed. Patients who underwent posterior lumbar spinal fusion of one to three levels as part of the ACS-NSQIP were identified. Patients without preoperative serum albumin concentration were excluded. Outcomes were compared between patients with and without hypoalbuminemia (defined as serum albumin concentration <3.5 g/dL). All comparisons were adjusted for baseline differences between populations. Four thousand three hundred ten patients were included. The prevalence of hypoalbuminemia was 4.8%. In comparison to patients with normal albumin concentration, patients with hypoalbuminemia had a higher risk for occurrence of wound dehiscence [1.5% vs. 0.2%, adjusted relative risk (RR) = 5.8, P = 0.006], SSI (5.4% vs. 1.7%, adjusted RR = 2.3, P = 0.010), and urinary tract infection (5.4% vs. 1.5%, adjusted RR = 2.5, P = 0.005). Similarly, patients with hypoalbuminemia had a higher risk for unplanned hospital readmission within 30 days of surgery (11.7% vs. 5.4%, RR = 1.8, P < 0.001). Finally, patients with hypoalbuminemia had a longer mean inpatient stay (5.2 vs. 3.7 days, RR = 1.2, P < 0.001). The present study suggests that malnutrition is an independent risk factor for infectious and wound complications following posterior lumbar fusion. Malnutrition was also associated with an

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

    SciTech Connect

    Masala, Salvatore; Tarantino, Umberto; Nano, Giovanni; Iundusi, Riccardo; Fiori, Roberto Da Ros, Valerio Simonetti, Giovanni

    2013-06-15

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

  9. Intradural Migration of a Sequestrated Lumbar Disc Fragment Masquerading as a Spinal Intradural Tumor

    PubMed Central

    Kim, Hyeong-Suk; Park, Jung-Soo

    2012-01-01

    Intervertebral intradural lumbar disc herniation (ILDH) is a quite rare pathology, and isolated intradural lumbar disc herniation is even more rare. Magnetic resonance imaging (MRI) may not be able to reveal ILDHs, especially if MRI findings show an intact lumbar disc annulus and posterior longitudinal ligament. Here, we present an exceedingly rare case of an isolated IDLH that we initially misidentified as a spinal intradural tumor, in a 54-year-old man hospitalized with a 2-month history of back pain and right sciatica. Neurologic examination revealed a positive straight leg raise test on the right side, but he presented no other sensory, motor, or sphincter disturbances. A gadolinium-enhanced MRI revealed what we believed to be an intradural extramedullary tumor compressing the cauda equina leftward in the thecal sac, at the L2 vertebral level. The patient underwent total L2 laminectomy, and we extirpated the intradural mass under microscopic guidance. Histologic examination of the mass revealed a degenerated nucleus pulposus. PMID:23091677

  10. Field potentials generated by group II muscle afferents in the lower-lumbar segments of the feline spinal cord

    PubMed Central

    Riddell, J S; Hadian, M

    2000-01-01

    The actions of group II muscle afferents projecting to the lower-lumbar (L6 and L7) segments of the cat spinal cord were investigated by recording the cord dorsum and focal synaptic field potentials evoked by electrical stimulation of hindlimb muscle nerves. Cord dorsum potentials recorded over the lower-lumbar segments were generally much smaller than those produced by group II afferents terminating within the midlumbar and sacral segments. Only group II afferents of tibialis posterior produced potentials with an amplitude (mean maximal amplitude 39 μV, n = 7) approaching that of potentials over other segments. Focal synaptic potentials (mean maximal amplitudes 135–200 μV) were evoked by group II afferents of the following muscle nerves, listed in order of effectiveness: quadriceps, tibialis posterior (throughout L6 and L7), gastrocnemius soleus, flexor digitorum longus, posterior biceps-semitendinosus and popliteus (mainly within L7). Field potentials were recorded in the dorsal horn (laminae IV–V) and also more ventrally in a region which included the lateral part of the intermediate zone (lateral to the large group I intermediate field potentials) and often extended into the ventral horn (laminae V–VII). The latencies of the group II potentials are considered compatible with the monosynaptic actions of the fastest conducting group II muscle afferents. The results are compared with morphological evidence on the pattern of termination of group II muscle afferents in the lower-lumbar segments and with previous descriptions of the actions of group II muscle afferents in midlumbar and sacral segments. PMID:10618155

  11. The Effects of Single-Level Instrumented Lumbar Laminectomy on Adjacent Spinal Biomechanics

    PubMed Central

    Bisschop, Arno; Holewijn, Roderick M.; Kingma, Idsart; Stadhouder, Agnita; Vergroesen, Pieter-Paul A.; van der Veen, Albert J.; van Dieën, Jaap H.; van Royen, Barend J.

    2014-01-01

    Study Design Biomechanical study. Objective Posterior instrumentation is used to stabilize the spine after a lumbar laminectomy. However, the effects on the adjacent segmental stability are unknown. Therefore, we studied the range of motion (ROM) and stiffness of treated lumbar spinal segments and cranial segments after a laminectomy and after posterior instrumentation in flexion and extension (FE), lateral bending (LB), and axial rotation (AR). These outcomes might help to better understand adjacent segment disease (ASD), which is reported cranial to the level on which posterior instrumentation is applied. Methods We obtained 12 cadaveric human lumbar spines. Spines were axially loaded with 250 N for 1 hour. Thereafter, 10 consecutive load cycles (4 Nm) were applied in FE, LB, and AR. Subsequently, a laminectomy was performed either at L2 or at L4. Thereafter, load-deformation tests were repeated, after similar preloading. Finally, posterior instrumentation was added to the level treated with a laminectomy before testing was repeated. The ROM and stiffness of the treated, the cranial adjacent, and the control segments were calculated from the load-displacement data. Repeated-measures analyses of variance used the spinal level as the between-subject factor and a laminectomy or instrumentation as the within-subject factors. Results After the laminectomy, the ROM increased (+19.4%) and the stiffness decreased (−18.0%) in AR. The ROM in AR of the adjacent segments also increased (+11.0%). The ROM of treated segments after instrumentation decreased in FE (−74.3%), LB (−71.6%), and AR (−59.8%). In the adjacent segments after instrumentation, only the ROM in LB was changed (−12.9%). Conclusions The present findings do not substantiate a biomechanical pathway toward or explanation for ASD. PMID:25649753

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

    PubMed

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

    2015-08-01

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

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

    SciTech Connect

    Masala, Salvatore; Fiori, Roberto; Bartolucci, Dario Alberto Volpi, Tommaso; Calabria, Eros; Novegno, Federica; Simonetti, Giovanni

    2012-04-15

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

  14. Posterior Branches of Lumbar Spinal Nerves - Part I: Anatomy and Functional Importance.

    PubMed

    Kozera, Katarzyna; Ciszek, Bogdan

    2016-01-01

    The aim of this paper is to compare anatomic descriptions of posterior branches of the lumbar spinal nerves and, on this basis, present the location of these structures. The majority of anatomy textbooks do not describe these nerves in detail, which may be attributable to the fact that for many years they were regarded as structures of minor clinical importance. The state of knowledge on these nerves has changed within the last 30 years. Attention has been turned to their function and importance for both diagnostic practice and therapy of lower back pain. Summarising the available literature, we may conclude that the medial and lateral branches separate at the junction of the facet joint and the distal upper edge of the transverse process; that the size, course and area supplied differ between the lateral and the medial branch; and that facet joints receive multisegmental innervation. It has been demonstrated that medial branches are smaller than the respective lateral branches and they have a more constant course. Medial branches supply the area from the midline to the facet joint line, while lateral branches innervate tissues lateral to the facet joint. The literature indicates difficulties with determining specific anatomic landmarks relative to which the lateral branch and the distal medial branch can be precisely located. Irritation of sensory fibres within posterior branches of the lumbar spinal nerves may be caused by pathology of facet joints, deformity of the spine or abnormalities due to overloading or injury. The anatomic location and course of posterior branches of spinal nerves should be borne in mind to prevent damaging them during low-invasive analgesic procedures.

  15. [Comparison of clinical efficacies of single segment transforaminal lumbar interbody fusion with cage versus autogenous morselized bone for degenerative lumbar spinal stenosis: a prospective randomized controlled study].

    PubMed

    Liu, Peisheng; Liu, Xiaozhen; Qiao, Xuejing; Du, Wennan; Luo, Dawei; Zheng, Xiujun

    2014-09-23

    To compare the clinical efficacies of single segment transforaminal lumbar interbody fusion (TLIF) with cage versus autogenous morselized bone for degenerative lumbar spinal stenosis. A total of 87 patients undergoing single segment TLIF were randomly divided into 2 groups. A cage was implanted into intervertebral space in group A patients while autogenous morselized bone in group B patients. Operative duration, blood loss, length of stay and cost of hospitalization of two groups were recorded. They were followed up at 1 week, 12, 24 months post-operation. Oswestry disability index (ODI), visual analogue scale (VAS) fusion rates, intervertebral space and foramen height restoration, lumbar lordosis and postoperative complications were compared between two groups. No significant inter-group difference existed in operative duration, blood loss or length of stay. However, the average hospitalization cost in group A were 18% higher than that of group B (P < 0.05). Both groups achieved excellent clinical outcomes within 2 years. ODI, VAS score improvement rates and postoperative complication rates were not statistically different. Lumbar fusion rate was 86.7% in group A versus 85.7% in group B after 2 years. And there was no significant difference (P > 0.05). The heights of intervertebral space and foramen in group A achieved a better recovery than those of group B. Both groups had similar improvements of lumbar lordosis. For degenerative lumbar spinal stenosis, usage of interbody cage is more effective in terms of recovery of intervertebral space and foraminal height compared with usage of bone graft. However it brings no better clinical efficacy while the usage of autogenous morselized bone is more cost-effective. Two grafting methods yield similar overall clinical outcomes.

  16. Plastic Changes in Lumbar Locomotor Networks after a Partial Spinal Cord Injury in Cats.

    PubMed

    Gossard, Jean-Pierre; Delivet-Mongrain, Hugo; Martinez, Marina; Kundu, Aritra; Escalona, Manuel; Rossignol, Serge

    2015-06-24

    After an incomplete spinal cord injury (SCI), we know that plastic reorganization occurs in supraspinal structures with residual descending tracts. However, our knowledge about spinal plasticity is rather limited. Our recent studies point to changes within the spinal cord below the lesion. After a lateral left hemisection (T10), cats recovered stepping with both hindlimbs within 3 weeks. After a complete section (T13) in these cats, bilateral stepping was seen on the next day, a skill usually acquired after several weeks of treadmill training. This indicates that durable plastic changes occurred below the lesion. However, because sensory feedback entrains the stepping rhythm, it is difficult to reveal central pattern generator (CPG) adaptation. Here, we investigated whether lumbar segments of cats with a chronic hemisection were able to generate fictive locomotion-that is, without phasic sensory feedback as monitored by five muscle nerves in each hindlimb. With a chronic left hemisection, the number of muscle nerves displaying locomotor bursts was larger on the left than on the right. In addition, transmission of cutaneous reflexes was relatively facilitated on the left. Later during the acute experiment, a complete spinalization (T13) was performed and clonidine was injected to induce rhythmic activities. There were still more muscle nerves displaying locomotor bursts on the left. The results demonstrate that spinal networks were indeed modified after a hemisection with a clear asymmetry between left and right in the capacity to generate locomotion. Plastic changes in CPG and reflex transmission below the lesion are thus involved in the stepping recovery after an incomplete SCI. Copyright © 2015 the authors 0270-6474/15/359446-10$15.00/0.

  17. Activation of neurotrophins in lumbar dorsal root probably contributes to neuropathic pain after spinal nerve ligation

    PubMed Central

    Kazemi, Abdolreza; Rahmati, Masoud; Eslami, Rasoul; Sheibani, Vahid

    2017-01-01

    Objective(s): Neurotrophins (NTs) exert various effects on neuronal system. Growing evidence indicates that NTs are involved in the pathophysiology of neuropathic pain. However, the exact role of these proteins in modulating nociceptive signaling requires being defined. Thus, the aim of this study was to evaluate the effects of spinal nerve ligation (SNL) on NTs activation in the lumbar dorsal root. Materials and Methods: Ten male Wistar rats were randomly assigned to two groups: tight ligation of the L5 spinal nerve (SNL: n=5) and Sham (n=5). In order to produce neuropathic pain, the L5 spinal nerve was tightly ligated (SNL). Then, allodynia and hyperalgesia tests were conducted weekly. After 4 weeks, tissue samples were taken from the two groups for laboratory evaluations. Here, Real-Time PCR quantity method was used for measuring NTs gene expression levels. Results: SNL resulted in a significant weight loss in the soleus muscle (P<0.05), mechanical allodynia and thermal hyperalgesia thresholds (respectively, P<0.05; P<0.05). Also, NGF, NT-4, NT-3, TrkA, TrkB and TrkC expression were up-regulated following spinal nerve ligation group (respectively, P=0.025, P=0.013, P=0.001, P=0.002, P<0.001, P=001) (respectively, 4.7, 5.2, 7.5, 5.1, 7.2, 6.2 folds). Conclusion: The present study provides new evidence that neuropathic pain induced by spinal nerve ligation probably activates NTs and Trk receptors expression in DRG. However, further studies are needed to better elucidate the role of NTs in a neuropathic pain. PMID:28133521

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

    PubMed

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

    2017-06-01

    Minimal longitudinal data exist regarding the role of lumbar musculature in predicting back pain and function. In cross-sectional study designs, there is often atrophy of the segmental multifidus muscle in subjects with low back pain compared with matched controls. However, the cross-sectional design of these studies prevents drawing conclusions regarding whether lumbar muscle characteristics predict or modify future back pain or function. The primary objective of this study is to determine whether the cross-sectional area (CSA) of lumbar muscles predict functional status or back pain at 6- or 12-month follow-up in older adults with spinal degeneration. The secondary objective is to evaluate whether these muscle characteristics improve outcome prediction above and beyond the prognostic information conferred by demographic and psychosocial variables. Secondary analysis of a randomized controlled trial. A total of 209 adults aged 50 years and older with clinical and radiographic spinal stenosis from the Lumbar Epidural steroid injection for Spinal Stenosis (LESS) trial. Using baseline magnetic resonance images, we calculated CSAs of the lumbar multifidus, psoas, and quadratus lumborum muscles using a standardized protocol by manually tracing the borders of each of the muscles. The relationship between lumbar muscle CSAs and baseline measures was assessed with Pearson or Spearman correlation coefficients. The relationship between lumbar muscle characteristics and 6- and 12-month Roland Morris Disability Questionnaire (RDQ) and back pain Numeric Rating Scale (NRS) responses was further evaluated with multivariate linear regression. A hierarchical approach to the regression was performed: a basic model with factors of conceptual importance including age, gender, BMI, and baseline RDQ score formed the first step. The second and third steps evaluated whether psychosocial variables or muscle measures conferred additional prognostic information to the basic model. Function

  19. Selective occlusion of lumbar arteries as a spinal cord ischemia model in rabbits.

    PubMed

    Maeda, Tomoyuki; Mori, Koichi; Shiraishi, Yoshimitsu; Tatebayashi, Kyoko; Kawai, Yasuaki

    2003-02-01

    Paraplegia is a devastating complication of operations requiring transient occlusion of the descending thoracic aorta. Many animal models of spinal cord ischemia have been utilized to examine the efficacy of various neuroprotective methods. In this study, we establish a rabbit model of spinal cord ischemia by selective temporary occlusion of lumbar arteries and examine the protective effects of systemic mild hypothermia in this model. Animals were divided into the following four groups: sham group (group A, n = 6); 10 min ischemia, normothermia (39 degrees C) (group B, n = 6); 20 min ischemia, normothermia (group C, n = 6); and 30 min ischemia, mild hypothermia (35 degrees C) (group D, n = 6). After 7 d of reperfusion, three rabbits in group B and five rabbits in group C developed paraplegia (Tarlov's score = 0). In contrast, all rabbits preserved hindlimb motor function (Tarlov's score = 4) in groups A and D. Histological findings indicated that the number of motor neurons in the anterior horns in group C were significantly fewer than in group A. A large number of motor neurons were preserved in group D. Hypothermia is known to be an effective and reliable method of neuroprotection, but the risk of complications rises at deep hypothermia. Our current results confirm that systemic, mild hypothermia is a safe and effective neuroprotective method during ischemia-reperfusion injury of the spinal cord.

  20. Metabolic Syndrome and 30-Day Outcomes in Elective Lumbar Spinal Fusion.

    PubMed

    Chung, Andrew S; Campbell, David; Waldrop, Robert; Crandall, Dennis

    2017-08-29

    Retrospective cohort study OBJECTIVE.: To evaluate the effect of MetS on 30-day morbidity and mortality following elective lumbar spinal fusion SUMMARY OF BACKGROUND DATA.: Metabolic syndrome (MetS) is a variable combination of hypertension, obesity, elevated fasting plasma glucose, and dyslipidemia.MetS has been associated with an increased risk of post-operative morbidity and mortality in multiple surgical settings. To our knowledge, the effect of MetS on 30-day outcomes following elective lumbar spinal fusion has not been well studied. An analysis of ACS-NSQIP data was performed between 2006-2013. Patients undergoing elective posterior lumbar fusion were identified. Emergency procedures, infections, tumor cases, and revision surgeries were excluded. Patients were defined as having MetS if they had a history of hypertension requiring medication, diabetes, and a BMI ≥ 30. 1,590 (10.2%) patients with MetS were identified. A mild increase in major (p = 0.040) and minor complications (p = 0.003) in patients with MetS was noted. MetS was associated with increased rates of pulmonary complications (1.9% compared to 1.0%; p = 0.001), sepsis (1.7% compared to 0.9%; p = 0.005), and acute post-op renal failure (0.4% compared to 0%; p < 0.001). Multivariate analysis confirmed MetS to be an independent predictor of pulmonary complications (OR 1.51; 95% CI 1.00 - 2.27; p = 0.048), sepsis (OR 1.56; 95% CI 1.01 to 2.42; p = 0.039), and acute post-operative renal failure (OR 6.95; 95% CI 2.23 to 21.67; p = 0.001). MetS status was associated with a mild increase in total hospital length of stay (4.38 days compared to 3.81 days; p < 0.001). While MetS is a predictor of post-operative acute renal failure, it only slightly increases the risk of overall complications and is not associated with increased rates of 30-day re-operations or re-admissions following elective lumbar fusion. 3.

  1. Load-bearing evaluation of spinal posterior column by measuring surface strain from lumbar pedicles. An in vitro study.

    PubMed

    Sun, Peidong; Zhao, Weidong; Bi, Zhenyu; Wu, Changfu; Ouyang, Jun

    2012-01-01

    An understanding of the load transfer within spinal posterior column of lumbar spine is necessary to determine the influence of mechanical factors on potential mechanisms of the motion-sparing implant such as artificial intervertebral disc and the dynamic spine stabilization systems. In this study, a new method has been developed for evaluating the load bearing of spinal posterior column by the surface strain of spinal pedicle response to the loading of spinal segment. Six cadaveric lumbar spine segments were biomechanically evaluated between levels L1 and L5 in intact condition and the strain gauges were pasted to an inferior surface of L2 pedicles. Multidirectional flexibility testing used the Panjabi testing protocol; pure moments for the intact condition with overall spinal motion and unconstrained intact moments of ±8 Nm were used for flexion-extension and lateral bending testing. High correlation coefficient (0.967-0.998) indicated a good agreement between the load of spinal segment and the surface strain of pedicle in all loading directions. Principal compressive strain could be observed in flexion direction and tensile strain in extension direction, respectively. In conclusion, the new method seems to be effective for evaluating posterior spinal column loads using pedicles' surface strain data collected during biomechanical testing of spine segments.

  2. Risk factor analysis for postoperative urinary retention after surgery for degenerative lumbar spinal stenosis.

    PubMed

    Lee, Sungjoon; Kim, Chi Heon; Chung, Chun Kee; Park, Sung Bae; Yang, Seung Heon; Kim, Soo Hyun; Kang, Soohee; Lee, Ju Hee; Choi, Yunhee

    2017-04-01

    Postoperative urinary retention (POUR) may not be considered a major complication after surgery for degenerative lumbar spinal stenosis. However, improper management of transient POUR leads to bladder overdistension and permanent bladder detrusor damage. Systematic monitoring of POUR may be recommended in vulnerable patients. The aim of the present study was to determine the incidence of and risk factors for POUR. This is a retrospective nested case-control study. A total of 284 consecutive patients (M : F=125:159; mean age, 63.3 years) who underwent spine surgery for degenerative lumbar spinal stenosis were reviewed. A multivariable logistic model was utilized to identify risk factors. A systematic postoperative voiding care protocol was applied for all patients to monitor them for the development of POUR. An indwelling urethral catheter was inserted intraoperatively and removed in the postanesthesia care unit. The patients were encouraged to void within 6 hours postoperatively and every 4-6 hours thereafter. After each voiding, the postvoid residual urine (PVR) was measured by an ultrasound bladder scan. POUR was defined as the inability to void or having a PVR≥100 mL for more than 2 days after surgery. The incidence of POUR was 27.1% (77/284). Older age (odds ratio, 1.062; 95% confidence interval, 1.029-1.095) and a long duration of surgery (odds ratio, 1.003; 95% confidence interval, 1.001-1.005) were significant risk factors. A formula for determining the probability of POUR was developed, and a probability of ≥0.26 was regarded as the cut-off value (sensitivity of 0.75 and specificity of 0.57; C-statics, 0.684). POUR was a common morbidity after surgery for degenerative lumbar spinal stenosis. We recommend adopting a systematic postoperative voiding care protocol to prevent bladder overdistension and detrusor damage, especially for elderly patients and those who have undergone longer surgeries. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Paraplegia caused by giant intradural herniation of a lumbar disk after combined spinal-epidural anesthesia in total hip arthroplasty.

    PubMed

    Sawai, Toshiyuki; Nakahira, Junko; Minami, Toshiaki

    2016-08-01

    Total paraplegia after epidural or spinal anesthesia is extremely rare. We herein report a case of total paraplegia caused by a giant intradural herniation of a lumbar disk at the L3-L4 level after total hip arthroplasty for coxarthrosis. The patient had no preoperative neurologic abnormalities. Intraoperative anesthetic management involved combined spinal-epidural anesthesia at the L3-L4 level with continuous intravenous propofol administration. Postoperatively, the patient complained of numbness and total paraplegia of the lower extremities. Magnetic resonance imaging showed a giant herniation of a lumbar disk compressing the spinal cord at the L3-L4 level. The intradural herniation was surgically treated, and the patient's symptoms completely resolved. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. [Injury to major blood vessels in anterior thoracic and lumbar spinal surgery].

    PubMed

    Stulík, J; Vyskocil, T; Bodlák, P; Sebesta, P; Kryl, J; Vojácek, J; Pafko, P

    2006-04-01

    The anterior approach to the thoracic and lumbar spine is used with increasing frequency for various indications. With the advent of prosthetic intervertebral disc replacement, its use has become even more frequent and has often been associated with serious complications. The aim of this study was to evaluate vascular complications in patients who underwent anterior spinal surgery of the thoracic and lumbar spine. We performed a total of 531 operations of the thoracolumbar spine from the anterior approach. In 12 cases, after exposure of the body of the first or second thoracic vertebrae, we employed the Smith-Robinson technique to expose the cervical spine. We used sternotomy in six, posterolateral thoracotomy in 209, the pararectal retroperitoneal approach in 239, anterolateral lumbotomy in 58 and the transperitoneal approach in seven patients. The aim of surgery was somatectomy in 190 patients and discectomy in 341 patients. Sternotomy and transperitoneal approaches were carried out by a thoracic or vascular surgeon and all the other procedures were done by the first author. The indications for spinal surgery included an accident in 171, tumor in 56, spondylodiscitis in 43 and a degenerative disease in 261 patients. All patients indicated for anterior spinal surgery were examined by conventional radiography in two projections, and this was completed by CT sagittal and frontal reconstructions of the affected region. Most patients also underwent MR imaging. The Smith-Robinson approach was used for exposure of T1 or T2. Sternotomy was indicated for treatment of T2-T4 and also T1 in the patients with a short, thick neck. Access to T3-L1 was gained by posterolateral thoracotomy, in most cases performed as a minimally invasive transpleural procedure. For access to the lumbar spine we usually used the retropleural approach from a pararectal incision or lumbotomy. We preferred the pararectal retroperitoneal approach in L2-S1 degenerative disease, L5 fractures, and L5-S1

  5. Conservative and Surgical Treatment Improves Pain and Ankle-Brachial Index in Patients with Lumbar Spinal Stenosis

    PubMed Central

    Yamashita, Masaomi; Murata, Yasuaki; Eguchi, Yawara; Aoki, Yasuchika; Ataka, Hiromi; Hirayama, Jiro; Ozawa, Tomoyuki; Morinaga, Tatsuo; Arai, Hajime; Mimura, Masaya; Kamoda, Hiroto; Orita, Sumihisa; Miyagi, Masayuki; Miyashita, Tomohiro; Okamoto, Yuzuru; Ishikawa, Tetsuhiro; Sameda, Hiroaki; Kinoshita, Tomoaki; Hanaoka, Eiji; Suzuki, Miyako; Suzuki, Munetaka; Aihara, Takato; Ito, Toshinori; Inoue, Gen; Yamagata, Masatsune; Toyone, Tomoaki; Kubota, Gou; Sakuma, Yoshihiro; Oikawa, Yasuhiro; Inage, Kazuhide; Sainoh, Takeshi; Yamauchi, Kazuyo; Takahashi, Kazuhisa

    2013-01-01

    Purpose The pathological mechanism of lumbar spinal stenosis is reduced blood flow in nerve roots and degeneration of nerve roots. Exercise and prostaglandin E1 is used for patients with peripheral arterial disease to increase capillary flow around the main artery and improve symptoms; however, the ankle-brachial index (ABI), an estimation of blood flow in the main artery in the leg, does not change after treatment. Lumbar spinal nerve roots contain somatosensory, somatomotor, and unmyelinated autonomic nerves. Improved blood flow by medication with prostaglandin E1 and decompression surgery in these spinal nerve roots may improve the function of nerve fibers innervating muscle, capillary, and main vessels in the lower leg, resulting in an increased ABI. The purpose of the study was to examine whether these treatments can improve ABI. Materials and Methods One hundred and seven patients who received conservative treatment such as exercise and medication (n=56) or surgical treatment (n=51) were included. Low back pain and leg pain scores, walking distance, and ABI were measured before treatment and after 3 months of conservative treatment alone or surgical treatment followed by conservative treatment. Results Low back pain, leg pain, and walking distance significantly improved after both treatments (p<0.05). ABI significantly increased in each group (p<0.05). Conclusion This is the first investigation of changes in ABI after treatment in patients with lumbar spinal stenosis. Improvement of the spinal nerve roots by medication and decompression surgery may improve the supply of blood flow to the lower leg in patients with lumbar spinal stenosis. PMID:23709437

  6. Simvastatin Ameliorates Cauda Equina Compression Injury in a Rat Model of Lumbar Spinal Stenosis

    PubMed Central

    Shunmugavel, Anandakumar; Martin, Marcus M.; Khan, Mushfiquddin; Copay, Anne G.; Subach, Brian R.; Schuler, Thomas C.

    2012-01-01

    Lumbar spinal stenosis (LSS) is the leading cause of morbidity and mortality worldwide. LSS pathology is associated with secondary injury caused by inflammation, oxidative damage and cell death. Apart from laminectomy, pharmacological therapy targeting secondary injury is limited. Statins are FDA-approved cholesterol-lowering drug. They also show pleiotropic anti-inflammatory, antioxidant and neuroprotective effects. To investigate the therapeutic efficacy of simvastatin in restoring normal locomotor function after cauda equina compression (CEC) in a rat model of LSS, CEC injury was induced in rats by implanting silicone gels into the epidural spaces of L4 and L6. Experimental group was treated with simvastatin (5 mg/kg body weight), while the injured (vehicle) and sham operated (sham) groups received vehicle solution. Locomotor function in terms of latency on rotarod was measured for 49 days and the threshold of pain was determined for 14 days. Rats were sacrificed on day 3 and 14 and the spinal cord and cauda equina fibers were extracted and studied by histology, immunofluorescence, electron microscopy (EM) and TUNEL assay. Simvastatin aided locomotor functional recovery and enhanced the threshold of pain after the CEC. Cellular Infiltration and demyelination decreased in the spinal cord from the simvastatin group. EM revealed enhanced myelination of cauda equina in the simvastatin group. TUNEL assay showed significantly decreased number of apoptotic neurons in spinal cord from the simvastatin group compared to the vehicle group. Simvastatin hastens the locomotor functional recovery and reduces pain after CEC. These outcomes are mediated through the neuroprotective and anti-inflammatory properties of simvastatin. The data indicate that simvastatin may be a promising drug candidate for LSS treatment in humans. PMID:23188522

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

    PubMed Central

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

    2015-01-01

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

  8. Minimally invasive removal of thoracic and lumbar spinal tumors using a nonexpandable tubular retractor.

    PubMed

    Nzokou, Andre; Weil, Alexander G; Shedid, Daniel

    2013-12-01

    Resection of spinal tumors traditionally requires bilateral subperiosteal muscle stripping, extensive laminectomy, and, in cases of foraminal extension, partial or radical facetectomy. Fusion is often warranted in cases of facetectomy to prevent deformity, pain, and neurological deterioration. Recent reports have demonstrated safety and efficacy of mini-open removal of these tumors using expandable tubular retractors. The authors report their experience with the minimally invasive removal of extradural foraminal and intradural-extramedullary tumors using the nonexpandable tubular retractor. A retrospective chart review of consecutive patients who underwent minimally invasive resection of spinal tumors at Notre Dame Hospital was performed. Between December 2005 and March 2012, 13 patients underwent minimally invasive removal of spinal tumors at Notre Dame Hospital, Montreal. There were 6 men and 7 women with a mean age of 55 years (range 20-80 years). There were 2 lumbar and 2 thoracic intradural-extramedullary tumors and 7 thoracic and 2 lumbar extradural foraminal tumors. Gross-total resection was achieved in 12 patients. Subtotal resection (90%) was attained in 1 patient because the tumor capsule was adherent to the diaphragm. The average duration of surgery was 189 minutes (range 75-540 minutes), and the average blood loss was 219 ml (range 25-500 ml). There were no major procedure-related complications. Pathological analysis revealed benign schwannoma in 8 patients and meningioma, metastasis, plasmacytoma, osteoid osteoma, and hemangiopericytoma in 1 patient each. The average equivalent dose of postoperative narcotics after surgery was 66.3 mg of morphine. The average length of hospitalization was 66 hours (range 24-144 hours). All working patients returned to normal activities within 4 weeks. The average MRI and clinical follow-up were 13 and 21 months, respectively (range 2-68 months). At last follow-up, 92% of patients had improvement or resolution of pain

  9. Non-fusion technology in degenerative lumbar spinal disorders: facts, questions, challenges.

    PubMed

    Mayer, H Michael; Korge, Andreas

    2002-10-01

    Although surgical fusion of the painful degenerating functional spinal unit (FSU) of the lumbar spine has always been a matter of debate, it has become a gold-standard procedure for all cases that lack an alternative treatment. However, a detailed and honest review of the clinical data reveals a considerable number of undesired side effects, complications and poor outcomes. The continuous search for alternative surgical treatment modalities has led to the development of numerous ideas for surgical reconstruction of the anterior and/or posterior column. The term "spine arthroplasty" summarises all procedures that have the goal of restoring function. This article describes the principles of the most current surgical techniques and implants, it points out potential challenges and poses a number of questions that need evidence-based answers before the incorporation of these innovations into surgical routine can be justified.

  10. Myeloscopic observation of adhesive arachnoiditis in patients with lumbar spinal canal stenosis.

    PubMed

    Kawauchi, Y; Yone, K; Sakou, T

    1996-07-01

    In this study a myeloscope was used to assess the influence of adhesive arachnoiditis on the surgical outcome of patients with lumbar spinal canal stenosis (LSS). The presence or absence and the degree of the complication of adhesive arachnoiditis were preoperatively determined by myeloscopy in 36 patients with LSS, and these findings were compared with the postoperative results. Various degrees of adhesive changes in the cauda equina were observed in all 36 patients. Patients with marked adhesions, which may indicate a blocked cauda equina, had distinctly worse operative results than did patients with slight or moderate adhesions. Adhesive arachnoiditis was considered to be one of the causes for the poor operative results for LSS. Myeloscopy is useful in diagnosing the morbid condition of the cauda equina in LSS, and for predicting the operative results.

  11. [Results of decompressive-stabilizing procedures via unilateral approach in lumbar spinal stenosis].

    PubMed

    Krut'ko, A V

    2012-01-01

    Aim of this study was to investigate the capabilities, advantages and limitations of bilateral decompression via unilateral approach in decompressive-stabilizing procedures in patients with degenerative lumbar spine disease, and to develop the technology and its technical performance. The controlled study included 372 patients (age range was 27-74 years). All of them were operated due to clinical manifestation of lumbar spinal stenosis. The main group consisted of 44 patients who underwent bilateral decompression via unilateral approach with stabilization of involved segments. The control group included 328 patients who were operated using standard bilateral technique with stabilization. A total of 52 segments were treated in the first group and 351 in the second one. In all patients with neurogenic intermittent claudication symptoms relieved after decompressive-stabilizing surgery. Analysis of duration of surgery (considering 1 segment) demonstrated that less invasive technique requires as much time as conventional. However mean intraoperative blood loss in the first group was twice as low as the second. Neither patient from the first group required hemotransfusion while in the second group in 57 (17.4%) cases hemotransfusion was performed due to blood loss. In the early postoperative period in both groups intensity of pain (according to VAS) gradually decreased. Mean hospital stay was 9.9 +/- 3.1 day in the main group and 14.7 +/- 4.7 days in the control group. Bilateral spinal canal decompression via unilateral approach decreases surgical trauma, blood loss, complication rate and hospital stay. Postoperative results are comparable with conventional technique.

  12. Therapeutic efficacy of pregabalin in patients with leg symptoms due to lumbar spinal stenosis.

    PubMed

    Takahashi, Naoto; Arai, Itaru; Kayama, Satoru; Ichiji, Kenji; Fukuda, Hironari; Kaga, Takahiro; Konno, Shin-Ichi

    2014-01-01

    The purpose of this study was to evaluate the therapeutic efficacy of pregabalin in patients with leg symptoms due to lumbar spinal stenosis. Study subjects were classified into two groups according to their pharmacotherapy: the pregabalin group, treated with nonsteroidal anti-inflammatory drug and pregabalin combination therapy, and the control group, treated with nonsteroidal anti-inflammatory drug monotherapy. The two groups were compared in terms of the duration of pain after the onset of leg symptoms and the type of neurogenic intermittent claudication, whether radicular-, caudal-, or mixed-type. Numerical rating scale and Roland-Morris Disability Questionnaire scores were evaluated before and 3 months after treatment. After 3 months of treatment, there were significant differences in the numerical rating scale for radicular- and mixed-types, but not for caudal-type, between the two groups in the subjects with leg symptoms for greater than 3 months. There were significant differences between the two groups in Roland-Morris Disability Questionnaire scores for mixed-type, but not for radicular- and caudal-types, in the subjects with leg symptoms for less than 3 months and for radicular- and mixed-types, but not for caudal-type, in the subjects with leg symptoms for greater than 3 months. Nonsteroidal anti-inflammatory drug and pregabalin combination therapy may be more effective than nonsteroidal anti-inflammatory drug monotherapy for the relief of leg symptoms due to lumbar spinal stenosis, preventing aggravation of subjective symptoms and improving quality of life for patients with radicular- and mixed-types in subjects with leg symptoms for greater than 3 months, although it may be necessary to consider alternative therapy for patients with caudal-type.

  13. Technical advances in minimally invasive surgery: direct decompression for lumbar spinal stenosis.

    PubMed

    Lauryssen, Carl

    2010-12-15

    Literature review, technique overview, prospective and retrospective data analysis. To review current minimally invasive surgery (MIS) methods of decompression for lumbar spinal stenosis and present a decompression technique using a flexible microblade shaver system. Several MIS decompression techniques for stenosis have been developed to minimize damage to soft tissues and reduce the amount of posterior element resection. Decompression using linearly configured instruments may not be able to adequately address stenosis in the neural foramen. A flexible microblade shaver system is able to traverse the foramen, removing bone and ligament, using a ventral to dorsal approach, rather than medial to lateral. This enables it to effectively decompress the lateral recess and neural foramen while sparing posterior structures. Brief literature review of current MIS decompression techniques is presented. MIS decompression using a flexible microblade shaver system is described with 1 year outcomes from a small pilot study and a retrospective chart review at 2 centers. A small postmarket pilot study (n = 9) with 1 year results showed positive patient outcomes using Visual Analog Scale (decrease by 73%), Oswestry Disability Index(50% improvement), Zurich Claudication Questionnaire physical function and symptom severity (improved by 72% and 31%, respectively), and Short-Form 36 (SF-36) Physical Component Score (36% improvement). Sixty-seven patients from a retrospective chart review at 2 centers had an average of 2 levels per patient decompressed using a flexible microblade shaver system. No patient has returned for additional surgery and there have been no cases of neurologic impairment. Current decompression techniques may result in inadequate decompression of the neural foramen or excessive resection of the facet joint. MIS decompression using a flexible microblade shaver system represents a way to perform an effective, facet-preserving decompression for patients with lumbar

  14. Incidence of thromboembolic complications in lumbar spinal surgery in 1,111 patients

    PubMed Central

    Nicol, Malcolm; Sun, Yu; Craig, Niall

    2009-01-01

    Deep venous thrombosis (DVT) and pulmonary embolism (PE) cause significant morbidity and mortality in orthopaedic surgical practice, although the incidence following surgery to the lumbosacral spine is less than following lower limb surgery. Our objective was to compare our rate of thromboembolic complications with those published elsewhere and investigate whether the adoption of additional pharmacological measures reduced the incidence of clinically evident DVT and PE. This retrospective study was undertaken to investigate the incidence of DVT/PE during the 10 years from 1 January 1985 to 31 December 1994, and then to assess the effectiveness of an anticoagulant policy introduced during 1995 using low dose aspirin or LMH in high risk cases. All records for spinal operations were reviewed for thrombo-embolic complications by reference to the Scottish Morbidity Record form SMR1. To ensure that all patients were compliant with the policy, data for the whole of 1995 was omitted and the period 1 January 1996 to 31 December 2003 was taken to assess its effectiveness. Surgery was done with the patient in the kneeling, seated prone position which leaves the abdomen free and avoids venous kinking in the legs. Records of a total of 1,111 lumbar spine operations were performed from 1 January 1985 to 31 December 2004 were reviewed. The overall incidence of thrombo-embolic complications was 0.29%. A total of 697 operations were performed from 1 January 1985 to 31 December 1994 with two cases of DVT and no cases of PE giving thromboembolic complication rate of 0.29%. During the period 1 January 1996 to 31 December 2003, 414 operations resulted in one case of DVT and no cases of PE, a rate of 0.24%. The incidence of symptomatic thrombo-embolic complications in lumbar spinal surgery is low in the kneeling, seated prone operating position, whether or not anticoagulation is used. PMID:19484271

  15. Prognostic Factors of Surgical Outcome after Spinous Process-Splitting Laminectomy for Lumbar Spinal Stenosis

    PubMed Central

    Tachibana, Toshiya; Inoue, Shinichi; Arizumi, Fumihiro; Yoshiya, Shinichi

    2015-01-01

    Study Design A retrospective case review. Purpose To assess the clinical and radiographic outcomes and identify the predictive factors associated with poor clinical outcomes after lumbar spinous process-splitting laminectomy (LSPSL) for lumbar spinal stenosis (LSS). Overview of Literature LSPSL is an effective surgical treatment for LSS. Special care should be taken in patients with degenerative lumbar scoliosis (DLS). Methods A consecutive retrospective case review of patients undergoing LSPSL for LSS with a minimum 2-year follow-up was performed. Mild DLS and mild degenerative spondylolisthesis (DS) were included in the study. The Japanese Orthopedic Association (JOA) score and recovery rate were reviewed. Poor clinical outcome was defined as a recovery rate <50% using Hirabayashi's method. Results A total of 52 patients (mean age, 72 years) met the inclusion criteria and had a mean follow-up of 2.6 years (range, 2-4.5 years). The preoperative diagnosis was LSS in 19, DS in 19, and DLS in 14 cases. The mean JOA score significantly increased from 14.6 to 23.2 at the final follow-up. The overall mean recovery rate was 60.1%. Thirteen patients (25%) were assigned to the poor outcome group. A higher rate of pre-existing DLS was observed in the poor outcome (poor) group (good, 15%; poor, 62%; p=0.003) than in the good outcome (good) group. None of the patient factors examined were associated with a poor outcome. A progression of slippage ≥5 mm was found in 8 of 24 patients (33%) in the DS group. A progression of curvature ≥5° was found in 5 of 14 patients (36%) in the DLS group. The progression of scoliosis and slippage did not influence the clinical outcome. Conclusions The clinical and radiographic outcomes of LSPSL for LSS were favorable. Pre-existing DLS was significantly associated with poor clinical outcome. PMID:26435788

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

    PubMed

    Chambers, Hannah

    2013-06-01

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

  17. Long-term results of surgery for lumbar spinal stenosis: a randomised controlled trial.

    PubMed

    Slätis, Pär; Malmivaara, Antti; Heliövaara, Markku; Sainio, Päivi; Herno, Arto; Kankare, Jyrki; Seitsalo, Seppo; Tallroth, Kaj; Turunen, Veli; Knekt, Paul; Hurri, Heikki

    2011-07-01

    We randomised a total of 94 patients with long-standing moderate lumbar spinal stenosis (LSS) into a surgical group and a non-operative group, with 50 and 44 patients, respectively. The operative treatment comprised undercutting laminectomy of stenotic segments, augmented with transpedicular-instrumented fusion in suspected lumbar instability. The primary outcome was the Oswestry disability index (ODI), and the other main outcomes included assessments of leg and back pain and self-reported walking ability, all based on questionnaire data from 85 patients at the 6-year follow-up. At the 6-year follow-up, the mean difference in ODI in favour of surgery was 9.5 (95% confidence interval 0.9-18.1, P-value for global difference 0.006), whereas the intensity of leg or back pain did not differ between the two treatment groups any longer. Walking ability did not differ between the treatment groups at any time. Decompressive surgery of LSS provided modest but consistent improvement in functional ability, surpassing that obtained after non-operative measures.

  18. Clinical and radiological outcomes of spinal endoscopic discectomy-assisted oblique lumbar interbody fusion: preliminary results.

    PubMed

    Heo, Dong Hwa; Kim, Jin-Sung

    2017-08-01

    OBJECTIVE Direct neural decompression cannot be achieved by performing lateral lumbar interbody fusion (LLIF). To overcome the indirect decompressive effect of LLIF, additional endoscopic discectomy with oblique lumbar interbody fusion (OLIF) has been attempted. The purpose of this study was to assess the clinical and radiological outcomes of patients who underwent OLIF with additional endoscopic discectomy. METHODS Spinal endoscopic discectomy-assisted OLIF was attempted to remove herniated disc material. Only patients with a follow-up time that exceeded 12 months were enrolled. Clinical parameters examined were the Oswestry Disability Index and visual analog scale scores of back and leg pain. Postoperative MRI was also performed. RESULTS Fourteen patients were enrolled. Central and foraminal disc herniations were evident in 8 and 6 patients, respectively. Concomitant central or foraminal herniated discs were removed completely after additional endoscopic discectomy, and disc removal was confirmed by postoperative MRI. Mean preoperative visual analog scale scores and Oswestry Disability Index scores improved postoperatively. CONCLUSIONS OLIF with additional endoscopic discectomy results in successful direct neural decompression without posterior decompressive procedures. Endoscopic assistance might overcome the limitations of LLIF.

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

    PubMed

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

    2011-09-01

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

  20. Redundant nerve roots of the cauda equina in lumbar spinal canal stenosis, an MR study on 500 cases.

    PubMed

    Poureisa, Masoud; Daghighi, Mohammad Hossein; Eftekhari, Payam; Bookani, Kaveh Rezaei; Fouladi, Daniel Fadaei

    2015-10-01

    The purpose of this study was to evaluate magnetic resonance (MR)-detected redundant nerve roots (RNRs) of the cauda equina in patients with lumbar spinal canal stenosis. A total of 500 lumbar MR studies in patients with lumbar spinal canal stenosis were reviewed for the presence and characteristics of RNRs of the cauda equina. The length of the RNRs relative to the height of the upper vertebral body of the level of the stenosis was used as a prognostic indicator. RNRs were detected in 15% of the patients, the majority above the level of the stenosis (85%) and loop shaped (72%). Advanced age (i.e., ≥56 years old, odds ratio=1), a lumbar spinal canal stenosis at L2-4 (odds ratio=2.5), and the presence of an intracanal protuberance with sharp margin in the site of the stenosis (odds ratio=7.2) were independent risk factors for the development of RNRs. A direct, significant correlation was found between the relative length of the RNRs and patients' age (Pearson r=0.36, p=0.001). The mean relative length of the RNRs was significantly higher in patients with RNRs located above the level of the stenosis than those with RNRs located below the site of the block. The degree of stenosis was associated with neither the presence nor the relative length of the RNRs. With an occurrence rate of 15%, RNRs of the cauda equina are not uncommon in cases with lumbar spinal canal stenosis. Advanced age, a canal stenosis at L2-4, and the presence of a sharp intracanal protuberance in the site of the stenosis are the related risk factors. Patients' age and the location of RNRs may be of prognostic value.

  1. An analysis of spinopelvic sagittal alignment after lumbar lordosis reconstruction for degenerative spinal diseases: how much balance can be obtained?

    PubMed

    Liu, Hui; Li, Sibei; Wang, Jiranru; Wang, Taiping; Yang, Hao; Li, Zemin; Li, Xiang; Zheng, Zhaomin

    2014-12-15

    A retrospective and radiological study of degenerative spinal diseases. To explore the changes in spinopelvic sagittal alignment after lumbar instrumentation and fusion of degenerative spinal diseases. Efforts have been paid to clarify the ideal postoperative sagittal profile for degenerative spinal diseases. However, little has been published about the actual changes of sagittal alignment after lumbar lordosis reconstruction. Radiographical analysis of 83 patients with spinal degeneration was performed by measuring sagittal parameters before and after operations. Comparative studies of sagittal parameters between short (1 level) and long (≥ 2 level) instrumentation and fusion were performed. Different variances (Δ) of these sagittal parameters before and after operations were calculated and compared. Correlative study and linear regression were performed to establish the relationship between variances. No significant changes were shown in the short-fusion group postoperatively. In the long-fusion group, postoperative lumbar lordosis (LL) and sacral slope (SS) were significantly increased; pelvic tilt (PT), sagittal vertical axis (SVA), pelvic incidence minus lumbar lordosis, and PT/SS were significantly decreased. Different variances of ΔLL, ΔSS, ΔPT, ΔSVA, Δ(pelvic incidence - LL), and ΔPT/SS were significantly greater in the long-fusion group than the short-fusion group. Close correlations were mainly shown among ΔLL, ΔPT, and ΔSVA. Linear regression equations could be developed (ΔPT = -0.185 × ΔLL - 7.299 and ΔSVA = -0.152ΔLL - 1.145). In degenerative spinal diseases, long instrumentation and fusion (≥ 2 levels) provides more efficient LL reconstruction. PT, SS, and SVA improve corresponding to LL in a linear regression model. Linear regression equations could be developed and used to predict PT and SVA change after long instrumentation and fusion for LL reconstruction.

  2. Posterior spinal fusion for adolescent idiopathic thoracolumbar/lumbar scoliosis: clinical outcomes and predictive radiological factors for extension of fusion distal to caudal end vertebra.

    PubMed

    Roberts, S B; Tsirikos, A I; Subramanian, A S

    2014-08-01

    Clinical, radiological, and Scoliosis Research Society-22 questionnaire data were reviewed pre-operatively and two years post-operatively for patients with thoracolumbar/lumbar adolescent idiopathic scoliosis treated by posterior spinal fusion using a unilateral convex segmental pedicle screw technique. A total of 72 patients were included (67 female, 5 male; mean age at surgery 16.7 years (13 to 23)) and divided into groups: group 1 included 53 patients who underwent fusion between the vertebrae at the limit of the curve (proximal and distal end vertebrae); group 2 included 19 patients who underwent extension of the fusion distally beyond the caudal end vertebra. A mean scoliosis correction of 80% (45% to 100%) was achieved. The mean post-operative lowest instrumented vertebra angle, apical vertebra translation and trunk shift were less than in previous studies. A total of five pre-operative radiological parameters differed significantly between the groups and correlated with the extension of the fusion distally: the size of the thoracolumbar/lumbar curve, the lowest instrumented vertebra angle, apical vertebra translation, the Cobb angle on lumbar convex bending and the size of the compensatory thoracic curve. Regression analysis allowed an equation incorporating these parameters to be developed which had a positive predictive value of 81% in determining whether the lowest instrumented vertebra should be at the caudal end vertebra or one or two levels more distal. There were no differences in the Scoliosis Research Society-22 outcome scores between the two groups (p = 0.17). In conclusion, thoracolumbar/lumbar curves in patients with adolescent idiopathic scoliosis may be effectively treated by posterior spinal fusion using a unilateral segmental pedicle screw technique. Five radiological parameters correlate with the need for distal extension of the fusion, and an equation incorporating these parameters reliably informs selection of the lowest instrumented

  3. Locomotor-activated neurons of the cat. II. Noradrenergic innervation and colocalization with NEα 1a or NEα 2b receptors in the thoraco-lumbar spinal cord.

    PubMed

    Noga, Brian R; Johnson, Dawn M G; Riesgo, Mirta I; Pinzon, Alberto

    2011-04-01

    Norepinephrine (NE) is a strong modulator and/or activator of spinal locomotor networks. Thus noradrenergic fibers likely contact neurons involved in generating locomotion. The aim of the present study was to investigate the noradrenergic innervation of functionally related, locomotor-activated neurons within the thoraco-lumbar spinal cord. This was accomplished by immunohistochemical colocalization of noradrenergic fibers using dopamine-β-hydroxylase or NEα(1A) and NEα(2B) receptors with cells expressing the c-fos gene activity-dependent marker Fos. Experiments were performed on paralyzed, precollicular-postmamillary decerebrate cats, in which locomotion was induced by electrical stimulation of the mesencephalic locomotor region. The majority of Fos labeled neurons, especially abundant in laminae VII and VIII throughout the thoraco-lumbar (T13-L7) region of locomotor animals, showed close contacts with multiple noradrenergic boutons. A small percentage (10-40%) of Fos neurons in the T7-L7 segments showed colocalization with NEα(1A) receptors. In contrast, NEα(2B) receptor immunoreactivity was observed in 70-90% of Fos cells, with no obvious rostrocaudal gradient. In comparison with results obtained from our previous study on the same animals, a significantly smaller proportion of Fos labeled neurons were innervated by noradrenergic than serotonergic fibers, with significant differences observed for laminae VII and VIII in some segments. In lamina VII of the lumbar segments, the degree of monoaminergic receptor subtype/Fos colocalization examined statistically generally fell into the following order: NEα(2B) = 5-HT(2A) ≥ 5-HT(7) = 5-HT(1A) > NEα(1A). These results suggest that noradrenergic modulation of locomotion involves NEα(1A)/NEα(2B) receptors on noradrenergic-innervated locomotor-activated neurons within laminae VII and VIII of thoraco-lumbar segments. Further study of the functional role of these receptors in locomotion is warranted.

  4. Locomotor-activated neurons of the cat. II. Noradrenergic innervation and colocalization with NEα1a or NEα2b receptors in the thoraco-lumbar spinal cord

    PubMed Central

    Johnson, Dawn M. G.; Riesgo, Mirta I.; Pinzon, Alberto

    2011-01-01

    Norepinephrine (NE) is a strong modulator and/or activator of spinal locomotor networks. Thus noradrenergic fibers likely contact neurons involved in generating locomotion. The aim of the present study was to investigate the noradrenergic innervation of functionally related, locomotor-activated neurons within the thoraco-lumbar spinal cord. This was accomplished by immunohistochemical colocalization of noradrenergic fibers using dopamine-β-hydroxylase or NEα1A and NEα2B receptors with cells expressing the c-fos gene activity-dependent marker Fos. Experiments were performed on paralyzed, precollicular-postmamillary decerebrate cats, in which locomotion was induced by electrical stimulation of the mesencephalic locomotor region. The majority of Fos labeled neurons, especially abundant in laminae VII and VIII throughout the thoraco-lumbar (T13-L7) region of locomotor animals, showed close contacts with multiple noradrenergic boutons. A small percentage (10–40%) of Fos neurons in the T7-L7 segments showed colocalization with NEα1A receptors. In contrast, NEα2B receptor immunoreactivity was observed in 70–90% of Fos cells, with no obvious rostrocaudal gradient. In comparison with results obtained from our previous study on the same animals, a significantly smaller proportion of Fos labeled neurons were innervated by noradrenergic than serotonergic fibers, with significant differences observed for laminae VII and VIII in some segments. In lamina VII of the lumbar segments, the degree of monoaminergic receptor subtype/Fos colocalization examined statistically generally fell into the following order: NEα2B = 5-HT2A ≥ 5-HT7 = 5-HT1A > NEα1A. These results suggest that noradrenergic modulation of locomotion involves NEα1A/NEα2B receptors on noradrenergic-innervated locomotor-activated neurons within laminae VII and VIII of thoraco-lumbar segments. Further study of the functional role of these receptors in locomotion is warranted. PMID:21307324

  5. Weight-based determination of spinal canal depth for paediatric lumbar punctures.

    PubMed

    Bailie, Helen C; Arthurs, Owen J; Murray, Matthew J; Kelsall, A Wilf

    2013-11-01

    The aim of this study was to evaluate whether spinal canal depth (SCD), measured using ultrasound, could be estimated from simple body measurements in a sample of children. We measured SCD in a group of 225 children aged 0-18 years in the curved left lateral position using ultrasound. Statistical analysis was performed using Pearson's correlation coefficient at the 5% level of significance. We also performed linear regression analyses (analysis of variance) for mid-spinal canal depth (MSCD), including five potential predictors of age, gender, height, weight and body surface area, in each model. The mean MSCD was 33.0 mm (18.1-56.4) across the whole cohort. The best linear correlation of MSCD (mm) was found with weight (W; kg), approximating the formula MSCD=0.4W+20 (R(2)=0.72). Body weight accounted for 85% of the variance in the data (adjusted R(2)=0.72). Our formula gives values outside of the actual measured SCD range in 23/225 (10.2%) of cases and estimates MSCD at 24 mm at 10 kg, 32 mm at 30 kg and 40 mm at 50 kg. We demonstrate a good correlation between weight and MSCD in a large group of children. Use of the simple formula MSCD (mm)=0.4 W+20 could improve the success rates of lumbar puncture in the paediatric population, but remains to be validated.

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

    PubMed

    Verdú-López, Francisco; Beisse, Rudolf

    2014-01-01

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

  7. [The Effect of memantine on spinal alpha-motoneurons and on the content of dopamine, noradrenaline and serotonin in the striatum and lumbar spinal cord].

    PubMed

    Sontag, K H; Wand, P; Schwarz, M; Wesemann, W; Osborne, N N

    1982-01-01

    In the present paper the pharmacological effect of 1,3-dimethyl-5-aminoadamantane (DMAA, D-145, memantine, Memantine was investigated on the reflex activity of spinal alpha-motoneurones of the cat and on spontaneous hyperactivity of alpha-motoneurones of spastic Han-Wist rats. The activity of both systems is reduced by the drug. Furthermore the content of dopamine, noradrenaline, and serotonin of striatum and lumbar spinal cord of normals and mutants is dose dependently decreased. It is assumed that memantine depresses the activation of central nervous membranes and reduces repetitive discharges of axons and in addition acts by release of neurotransmitters.

  8. Regeneration of a spinal ligament after total lumbar disk arthroplasty in primates.

    PubMed

    Cunningham, Bryan W; Berven, Sigurd H; Hu, Nianbin; Beatson, Helen J; De Deyne, Patrick G; McAfee, Paul C

    2009-01-01

    Total disk arthroplasty (TDA) is a new procedure that replaces the intervertebral disk space with an artificial motion segment and necessitates the resection of the anterior longitudinal ligament (ALL). We assessed whether a collagen-based graft made from porcine small-intestine submucosa (SIS) can be used as a regenerative scaffold to restore the function and structure of the ALL in the lumbar spine. A total of 10 mature male baboons underwent TDA at L5-L6 using one of two treatments: (1) TDA only (n = 5) or (2) TDA combined with SIS (n = 5). Six months postoperatively, mock revision surgery was performed to assess tissue adhesions followed by non-destructive multidirectional flexibility testing of the spinal segment. The vertebral segments were then processed for histology. The tissue adhesion score was 2.8 +/- 0.8 in the TDA only group and 1.8 +/- 1.4 in the TDA-SIS group (p = 0.2). Segmental range of motion and the length of the neutral zone were similar in both groups. Histology showed that the SIS scaffold led to an organized ligamentous structure with a significantly (p = 0.027) higher thickness (2.18 +/- 0.25 mm) compared to the connective tissue structure in the TDA-only group (1.66 +/- 0.33 mm). We concluded that using a SIS bioscaffold after TDA did not lead to increased great vessel adhesion while its use facilitated the formation of highly organized ligamentous tissues. However, the SIS- induced and newly formed ligamentous tissue anterior to the spinal segment did not lead to a measurable limitation of spinal extension. 2009 S. Karger AG, Basel.

  9. Clinical significance of postdecompression facet joint effusion after minimally invasive decompression for degenerative lumbar spinal stenosis.

    PubMed

    Pao, Jwo-Luen; Chen, Wen-Chih; Chang, Chih-Hung; Chen, Chiang-Sang; Wang, Jaw-Lin

    2014-12-01

    A retrospective case series study. To investigate the clinical significance of postdecompression facet effusion (PDFE) after microendoscopic decompressive laminotomy (MEDL). The facet joint effusion noted on magnetic resonance imaging was considered as an indicator of degeneration of the facet joints and segmental instability. PDFE occurring after MEDL might imply postdecompression segmental instability. Its clinical significance has not yet been clarified. From 2005 to 2010, 165 patients with degenerative lumbar spinal stenosis (average age: 64.5, average follow-up: 25.8 mo) who received MEDL were reviewed. We investigated the incidence of PDFE with preoperative and repetitive magnetic resonance imaging at 6 months postoperatively. The clinical data and treatment courses were reviewed. The treatment outcomes were evaluated with Oswestry Disability Index and Japanese Orthopedic Association scores. The incidence of PDFE was 17.0% (n=28), which was significantly higher in patients receiving multilevel decompression and patients with scoliosis or spondylolisthesis. The intensity of low back pain was similar between patients with and without PDFE, but "mechanical" low back pain was only noted in patients with PDFE. Of the 28 patients with PDFE, only 9 symptomatic patients required invasive treatment (5 facet joint steroid injection, 3 revision MEDL, and 1 spinal fusion). Although the postoperative Oswestry Disability Index and Japanese Orthopedic Association scores were significantly worse these 9 patients, the final outcomes were good. Progression of spondylolisthesis was noted in 2 patients without PDFE but no patients with PDFE during the follow-up period. The relatively high incidence of PDFE after MEDL suggests that injury to the integrity of facet joint is inevitable during decompression of the stenosis, even using minimally invasive techniques. However, the overall stability is well preserved with very rare progression of spondylolisthesis. Most patients with

  10. Sprouting capacity of lumbar motoneurons in normal and hemisected spinal cords of the rat

    PubMed Central

    Gordon, T; Tyreman, N

    2010-01-01

    Nerve sprouting to reinnervate partially denervated muscles is important in several disease and injury states. To examine the effectiveness of sprouting of active and inactive motor units (MUs) and the basis for a limit to sprouting, one of three rat lumbar spinal roots was cut under normal conditions and when the spinal cord was hemisected at T12. Muscle and MU isometric contractile forces were recorded and muscle fibres in glycogen-depleted single muscle units enumerated 23 to 380 days after surgery. Enlargement of intact MUs by sprouting was effective in compensating for up to 80% loss of innervation. For injuries that removed >70–80% of the intact MUs, muscle contractile force and weight dropped sharply. For partial denervation of <70%, all MUs increased contractile force by the same factor in both normally active muscles and muscles whose activity was reduced by T12 hemisection. Direct measurements of MU size by counting glycogen-depleted muscle fibres in physiologically and histochemically defined muscle units, provided direct evidence for a limit in MU size, whether or not the activity of the muscles was reduced by spinal cord hemisection. Analysis of spatial distribution of muscle fibres within the outer boundaries of the muscle unit demonstrated a progressive increase in fibres within the territory to the limit of sprouting when most of the muscle unit fibres were adjacent to each other. We conclude that the upper limit of MU enlargement may be explained by the reinnervation of denervated muscle fibres by axon sprouts within the spatial territory of the muscle unit, formerly distributed in a mosaic pattern. PMID:20519315

  11. Association between CT-evaluated lumbar lordosis and features of spinal degeneration, evaluated in supine position

    PubMed Central

    Kalichman, Leonid; Li, Ling; Hunter, David; Been, Ella

    2013-01-01

    Background Context Few studies have directly evaluated the association of lumbar lordosis and segmental wedging of the vertebral bodies and intervertebral disks with prevalence of spinal degenerative features. Purpose To evaluate the association of CT-evaluated lumbar lordosis, segmental wedging of the vertebral bodies and that of the intervertebral disks with various spinal degeneration features. Study design This cross-sectional study was a nested project to the Framingham Heart Study. Sample A random consecutive subset of 191 participants chosen from the 3590 participants enrolled in the Framingham Heart Study who underwent multi-detector CT to assess aortic calcification. Outcome Measures Physiologic Measures Dichotomous variables indicating the presence of intervertebral disc narrowing, facet joint osteoarthritis, spondylolysis, spondylolisthesis and spinal stenosis and density (in Hounsfield units) of multifidus and erector spinae muscles were evaluated on supine CT, as well as the lordosis angle (LA) and the wedging of the vertebral bodies and intervertebral disks. Sum of vertebral bodies wedging (ΣB) and sum of intervertebral discs wedging (ΣD) were used in analyses. Methods Mean values (±SD) of LA, ΣB and ΣD were calculated in males and females and compared using the t-test. Mean values (±SD) of LA, ΣB and ΣD in 4 age groups: <40, 40–49, 50–59 and 60+ years were calculated. We tested the linear relationship between LA, ΣB and ΣD and age groups. We evaluated the association between each spinal degeneration feature and LA, ΣB and ΣD using multiple logistic regression analysis where studied degeneration features were the dependent variable and all LA, ΣB and ΣD (separately) as well as age, sex, and BMI were independent predictors. Results LA was slightly lower than the normal range for standing individuals, and no difference was found between males and females (p=0.4107). However, the sex differences in sum of vertebral bodies wedging (

  12. Analysis of the Relationship between Ligamentum Flavum Thickening and Lumbar Segmental Instability, Disc Degeneration, and Facet Joint Osteoarthritis in Lumbar Spinal Stenosis

    PubMed Central

    Yoshiiwa, Toyomi; Notani, Naoki; Ishihara, Toshinobu; Kawano, Masanori; Tsumura, Hiroshi

    2016-01-01

    Study Design Cross-sectional study. Purpose To investigate the relationship between ligamentum flavum (LF) thickening and lumbar segmental instability and disc degeneration and facet joint osteoarthritis. Overview of Literature Posterior spinal structures, including LF thickness, play a major role in lumbar spinal canal stenosis pathogenesis. The cause of LF thickening is multifactorial and includes activity level, age, and mechanical stress. LF thickening pathogenesis is unknown. Methods We examined 419 patients who underwent computed tomography (CT) myelography and magnetic resonance imaging after complaints of clinical symptoms. To investigate LF hypertrophy, 57 patients whose lumbar vertebra had normal disc heights at L4–5 were selected to exclude LF buckling as a hypertrophy component. LF thickness, disc space widening angulation in flexion, segmental angulation, presence of a vacuum phenomenon, and lumbar lordosis at T12–S1 were investigated. Disc and facet degeneration were also evaluated. Facet joint orientation was measured via an axial CT scan. Results The mean LF thickness in all patients was 4.4±1.0 mm at L4–5. There was a significant correlation between LF thickness and disc degeneration; LF thickness significantly increased with severe disc degeneration and facet joint osteoarthritis. There was a tendency toward increased LF thickness in more sagittalized facet joints than in coronalized facet joints. Logistic regression analysis showed that LF thickening was influenced by segmental angulation and facet joint osteoarthritis. Patient age was associated with LF thickening. Conclusions LF hypertrophy development was associated with segmental instability and severe disc degeneration, severe facet joint osteoarthritis, and a sagittalized facet joint orientation. PMID:27994791

  13. Comparison of Outcomes of Anterior, Posterior, and Transforaminal Lumbar Interbody Fusion Surgery at a Single Lumbar Level with Degenerative Spinal Disease.

    PubMed

    Lee, Nam; Kim, Keung Nyun; Yi, Seong; Ha, Yoon; Shin, Dong Ah; Yoon, Do Heum; Kim, Keun Su

    2017-05-01

    The fusion rate in spinal surgery may vary in relation to the technique, and it remains unknown which surgical technique provides the best fusion rate and surgical outcome. We aimed to compare radiologic and surgical results between 3 surgical techniques used for lumbar interbody fusion. Participants included 77 patients diagnosed with degenerative spinal stenosis including spondylolytic spondylolisthesis. Patients were divided into 3 groups according to surgical technique: anterior lumbar interbody fusion (ALIF, n = 26), transforaminal lumbar interbody fusion (TLIF, n = 21), and posterior lumbar interbody fusion (PLIF, n = 30). Various radiologic parameters were measured, including fusion rates. Significant changes after surgery were observed in the ALIF group for the percentage of vertebral body slippage, anterior disk height, posterior disk height, and segmental range of movement (ROM). The fusion rate on computed tomography (CT) scan at the final follow-up was 69.2% in the ALIF group, 72.7% in the TLIF group, and 64.3% in the PLIF group. The cage subsidence rate 2 years after surgery was 15.4% in the ALIF group, 38.1% in the TLIF group, and 10% in the PLIF group. ALIF was associated with better restoration of segmental lordosis. The fusion rate on CT scan and with segmental ROM did not differ between the 3 groups. TLIF was associated with a better postoperative visual analog scale. PLIF showed the lowest cage subsidence rate. Therefore, it is difficult to know which surgical technique is better among the 3 groups because each surgical method has its own advantages. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. The Current Testing Protocols for Biomechanical Evaluation of Lumbar Spinal Implants in Laboratory Setting: A Review of the Literature

    PubMed Central

    Gonzalez-Blohm, Sabrina A.; Doulgeris, James J.; Lee, William E.; Shea, Thomas M.; Vrionis, Frank D.

    2015-01-01

    In vitro biomechanical investigations have become a routinely employed technique to explore new lumbar instrumentation. One of the most important advantages of such investigations is the low risk present when compared to clinical trials. However, the best use of any experimental data can be made when standard testing protocols are adopted by investigators, thus allowing comparisons among studies. Experimental variables, such as the length of the specimen, operative level, type of loading (e.g., dynamic versus quasistatic), magnitude, and rate of load applied, are among the most common variables controlled during spinal biomechanical testing. Although important efforts have been made to standardize these protocols, high variability can be found in the current literature. The aim of this investigation was to conduct a systematic review of the literature to identify the current trends in the protocols reported for the evaluation of new lumbar spinal implants under laboratory setting. PMID:25785272

  15. Whole-body vibration induces pain and lumbar spinal inflammation responses in the rat that vary with the vibration profile.

    PubMed

    Zeeman, Martha E; Kartha, Sonia; Winkelstein, Beth A

    2016-08-01

    Whole-body vibration (WBV) is linked epidemiologically to neck and back pain in humans, and to forepaw mechanical allodynia and cervical neuroinflammation in a rodent model of WBV, but the response of the low back and lumbar spine to WBV is unknown. A rat model of WBV was used to determine the effect of different WBV exposures on hind paw behavioral sensitivity and neuroinflammation in the lumbar spinal cord. Rats were exposed to 30 min of WBV at either 8 or 15 Hz on days 0 and 7, with the lumbar spinal cord assayed using immunohistochemistry at day 14. Behavioral sensitivity was measured using mechanical stimulation of the hind paws to determine the onset, persistence, and/or recovery of allodynia. Both WBV exposures induce mechanical allodynia 1 day following WBV, but only the 8 Hz WBV induces a sustained decrease in the withdrawal threshold through day 14. Similarly, increased activation of microglia, macrophages, and astrocytes in the superficial dorsal horn of the lumbar spinal cord is only evident after the painful 8 Hz WBV. Moreover, extracellular signal-regulated kinase (ERK)-phosphorylation is most robust in neurons and astrocytes of the dorsal horn, with the most ERK phosphorylation occurring in the 8 Hz group. These findings indicate that a WBV exposure that induces persistent pain also induces a host of neuroimmune cellular activation responses that are also sustained. This work indicates there is an injury-dependent response that is based on the vibration parameters, providing a potentially useful platform for studying mechanisms of painful spinal injuries. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1439-1446, 2016. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

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

    PubMed Central

    Denyer, Gareth S.; Keay, Kevin A.

    2015-01-01

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

  17. Molecular and cellular changes in the lumbar spinal cord following thoracic injury: regulation by treadmill locomotor training.

    PubMed

    Shin, Hae Young; Kim, Hyosil; Kwon, Min Jung; Hwang, Dong Hoon; Lee, KiYoung; Kim, Byung Gon

    2014-01-01

    Traumatic spinal cord injury (SCI) often leads to debilitating loss of locomotor function. Neuroplasticity of spinal circuitry underlies some functional recovery and therefore represents a therapeutic target to improve locomotor function following SCI. However, the cellular and molecular mechanisms mediating neuroplasticity below the lesion level are not fully understood. The present study performed a gene expression profiling in the rat lumbar spinal cord at 1 and 3 weeks after contusive SCI at T9. Another group of rats received treadmill locomotor training (TMT) until 3 weeks, and gene expression profiles were compared between animals with and without TMT. Microarray analysis showed that many inflammation-related genes were robustly upregulated in the lumbar spinal cord at both 1 and 3 weeks after thoracic injury. Notably, several components involved in an early complement activation pathway were concurrently upregulated. In line with the microarray finding, the number of microglia substantially increased not only in the white matter but also in the gray matter. C3 and complement receptor 3 were intensely expressed in the ventral horn after injury. Furthermore, synaptic puncta near ventral motor neurons were frequently colocalized with microglia after injury, implicating complement activation and microglial cells in synaptic remodeling in the lumbar locomotor circuitry after SCI. Interestingly, TMT did not influence the injury-induced upregulation of inflammation-related genes. Instead, TMT restored pre-injury expression patterns of several genes that were downregulated by injury. Notably, TMT increased the expression of genes involved in neuroplasticity (Arc, Nrcam) and angiogenesis (Adam8, Tie1), suggesting that TMT may improve locomotor function in part by promoting neurovascular remodeling in the lumbar motor circuitry.

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

    PubMed Central

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

    2016-01-01

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

  19. Effects of flexion-distraction manipulation therapy on pain and disability in patients with lumbar spinal stenosis.

    PubMed

    Choi, Jioun; Lee, Sangyong; Jeon, Chunbae

    2015-06-01

    [Purpose] This study examined the effects of flexion-distraction manipulation therapy on pain and disability in patients with lumbar spinal stenosis. [Subjects] Thirty patients with lumbar spinal stenosis were divided into two groups: a conservative treatment group (n=15) and a flexion-distraction manipulation group (n=15). [Methods] The conservative treatment group received conservative physical therapy, and the flexion-distraction group received both conservative physical therapy and flexion-distraction manipulation therapy. Both groups received treatment 3 times a week for 6 weeks. The Visual Analog Scale was used to measure pain intensity, and the Oswestry Disability Index was used to evaluate the level of disability caused by the pain. [Results] The Visual Analog Scale scores for pain were significantly decreased in both groups. In the between-group comparison, the decrease in pain was more significant in the flexion-distraction group. According to the Oswestry Disability Index, the level of disability was significantly decreased in both groups, but the decrease was more significant in the flexion-distraction group. [Conclusion] Flexion-distraction manipulation appears to be an effective intervention for pain and disability among patients with lumbar spinal stenosis.

  20. Clinical validation study to measure the performance of the Nerve Root Sedimentation Sign for the diagnosis of lumbar spinal stenosis.

    PubMed

    Staub, Lukas P; Barz, Thomas; Melloh, Markus; Lord, Sarah J; Chatfield, Mark; Bossuyt, Patrick M

    2011-05-01

    Lumbar spinal stenosis is a common degenerative disorder of the spine in elderly patients that can be effectively treated with decompression surgery in some patients. Radiological findings in the diagnostic work-up of the patients do not always correlate well with clinical symptoms, and guidance about when to proceed to surgery is inconsistent. The recently described Nerve Root Sedimentation Sign in magnetic resonance scans has been shown to discriminate well between selected patients with and without lumbar spinal stenosis, but the performance of this new test, when used in a broad patient population, is not yet known. We describe the design of a single-centre retrospective chart review to assess the clinical validity of the Sedimentation Sign by evaluating its association with health outcomes in patients with suspected lumbar spinal stenosis. The Sedimentation Sign will be cross-classified with decisions for surgery based on existing tests and patient outcomes in follow-up examinations at 24months. The results will be used to estimate: i) how well the Sedimentation Sign can distinguish between patients that do or do not benefit from surgery, and ii) the concordance between the Sedimentation Sign and existing tests to explore its possible value as a triage test. This study design will provide data to estimate the potential benefits and harms of using the Sedimentation Sign to guide surgical decisions. The observed proportion of discordant test results will help inform the design of future randomised controlled trials of the Sedimentation Sign. Copyright © 2011 Elsevier Inc. All rights reserved.

  1. Interspinous distractor devices for the management of lumbar spinal stenosis: a miracle cure for a common problem?

    PubMed

    Borg, Anouk; Nurboja, Besnik; Timothy, Jake; Choi, David

    2012-08-01

    Neurogenic claudication due to lumbar spinal stenosis is the commonest cause of back and leg pain in the elderly. It consumes large amounts of healthcare resource and is a common reason for GP consultations. Surgical management by decompressive laminectomy is the traditional method used for those patients in whom conservative management has failed. However, the advent of minimally invasive interspinous distraction devices, which are designed to alleviate symptoms of neurogenic intermittent claudication without subjecting the patient to a major operation, has potentially revolutionised the management of lumbar spinal stenosis. This review describes the principles of interspinous distraction devices, the rationale for their use in the management of lumbar spinal stenosis, indications and predictors of outcome. Published data on the safety and efficacy of the various devices available is encouraging but long term results are awaited. The superiority of interspinous distraction devices over conservative treatment has already been established, however, the precise indication for this new technology and whether the implants can replace conventional decompressive surgery in some situations has not been clearly defined.

  2. [Exercise reduced the need for operation in lumbar spinal stenosis. Circulatory load in the form of cycling gave good effect].

    PubMed

    Nord, Tomas; Kornerup, Ulf; Grönlund, Per; Reuterwall, Christina

    2015-01-27

    Conservative treatment is being reported to relieve walk related leg pain or improve life quality in patients with lumbar spinal stenosis. Such treatment often combines various interventions, making it difficult to identify single effective measures. At our clinic, specialized in spine surgery, the care of the patients with lumbar spinal stenosis starts with a 4 months training program when the patient typically uses a stationary bike at a circulatory load of about 70% of maximal capacity. Need of surgery is evaluated after the training period. The present study compares oxygen uptake capacity and walking capacity before and after the training period. The main findings are: no clear correlation between change of oxygen uptake capacity and change of walking distance; no correlation between individual cauda equina cross-sectional area and improvement of walking distance during the training program; almost half of the patients who completed the training program felt their lumbar spinal stenosis symptoms improved to such an extent that surgery was not required (26/54).

  3. Peripheral contributions to the mechanical hyperalgesia following a lumbar 5 spinal nerve lesion in rats.

    PubMed

    Jang, J H; Lee, B H; Nam, T S; Kim, J W; Kim, D W; Leem, J W

    2010-01-13

    Using lumbar 5 (L5) dorsal root rhizotomy-bearing rats, we examined the extent to which L5 spinal nerve lesion (SNL)-induced mechanical hyperalgesia was governed by two peripheral components, that is Wallerian degeneration (WD) and peripherally-propagating injury discharge (PID). The contribution of WD to SNL-induced hyperalgesia was studied by excluding PID with lidocaine treatment that blocked nerve conduction temporarily, but completely at the time of injury, whereas PID was examined separately by using brief tetanic electrical stimulation of the spinal nerve mimicking PID. Following the disappearance of L5 rhizotomy-induced transient hyperalgesia, L5 SNL resulted in long-lasting mechanical hyperalgesia as early as one day post-SNL despite a PID block, highlighting the role of WD. In a comparative experiment, a delayed onset of hyperalgesia (7 days) was measured in L3 rhizotomy-bearing rats following L3 SNL with a PID block, in which injured fiber (L3) was separated from intact fibers (L4 and L5) anatomically until they meet at the peripheral terminals, supporting the importance of interactions between degenerating and adjacent intact fibers for WD-induced hyperalgesia. Tetanic electrical stimulation of decentralized L5 spinal nerve resulted in mechanical hyperalgesia developing within 1 day and persisting for 7 days. This hyperalgesia was prevented by lidocaine blockade of the L5 nerve, and was unaffected by lidocaine blockades of the central inputs from L3 and L4 fibers during L5 nerve stimulation, suggesting the mediation of PID-induced hyperalgesia by sensitization, not activation, of peripheral terminals of adjacent intact afferents. The similar hyperalgesia was also observed following electrical stimulation of decentralized L3 spinal nerve. Prior elimination of L4 C-fibers by local capsaicin prevented hyperalgesia induced either by L5 SNL with a PID block or by L5 nerve stimulation. These results suggest that neighboring C-afferents remaining intact after

  4. The safety profile of lumbar spinal surgery in elderly patients 85 years and older.

    PubMed

    Wang, Michael Y; Widi, Gabriel; Levi, Allan D

    2015-10-01

    OBJECT The aging of the population will require that surgeons increasingly consider operating on elderly patients. Performing surgery safely in the elderly will require an understanding of the factors that predict successful outcomes and avoid complications. METHODS Records of patients 85 years and older undergoing elective lumbar spinal surgery were retrospectively reviewed. Microdiscectomies were excluded. Preexisting medical illnesses measured using the Charlson Comorbidity Index (CCI), American Society of Anesthesiologists (ASA) Physical Status class, age, and surgical parameters were analyzed as factors potentially predictive of complications. Ambulatory function was rated on a 4-point scale. RESULTS During the study 26 consecutive patients (mean age 87 years) with a mean ASA class of 2.6 ± 0.65 and CCI of 1.1 ± 1.27 were enrolled. The average number of levels treated was 2.17 ± 1.23, and 73% underwent fusion. The mean follow-up was 41.9 months with a minimum of 24 months, and all patients were alive at last follow-up. Average blood loss was 142 ± 184 ml, and the operative time was 183.3 ± 80.6 minutes. The mean number of levels treated was 2.17 ± 1.13 (range 1-4). Ambulatory function improved significantly by 0.59 ± 1.0 points. Five complications (19.2%) occurred in 4 patients, 2 major and 3 minor. Four complications were temporary and 1 was permanent. Patient age, blood loss, CCI score, ASA class, the number of levels treated, and fusion surgery were not statistically associated with a complication. Operative time of longer than 180 minutes (p = 0.0134) was associated with complications. CONCLUSIONS Lumbar spine surgery in patients 85 years and older can be accomplished safely if careful attention is paid to preoperative selection. Prolonged operative times are associated with a higher risk of complications.

  5. Relationship between sedimentation sign and morphological grade in symptomatic lumbar spinal stenosis.

    PubMed

    Laudato, P A; Kulik, G; Schizas, C

    2015-10-01

    We aimed to study the relationship between two morphological parameters recently described on MRI images in relation to lumbar spinal stenosis (LSS): the first is the sedimentation sign (SedS) and the second is the morphological grading of lumbar stenosis. MRIs from a total of 137 patients were studied. From those, 110 were issued from a prospective database of symptomatic LSS patients, of whom 73 were treated surgically and 37 conservatively based on symptom severity. A third group consisting of 27 subjects complaining of low back pain (LBP) served as control. Severity of stenosis was judged at disc level using the four A to D grade morphological classification. The presence of a SedS was judged at pedicle level, above or below the site of maximal stenosis. A positive SedS was observed in 58, 69 and 76% of patients demonstrating B, C and D morphology, respectively, but in none with grade A morphology. The SedS was positive in 67 and 35% of the surgically and conservatively treated patients, respectively, and in 8% of the LBP group. C and D morphological grades were present in 97 and 35% of patients in the surgically and conservatively treated group, respectively, and in 18% of the LBP group. Presence of a positive SedS carried an increased risk of being submitted to surgery in the symptomatic LSS group (OR 3.5). This risk was even higher in the LSS patients demonstrating grade C or D morphology (OR 65). One-third of surgically treated LSS patients do not present a SedS. This sign appears to be a lesser predictor of treatment modality in our setting of symptomatic LSS patients compared to the severity of stenosis judged by the morphological grade.

  6. Consensus on the clinical diagnosis of lumbar spinal stenosis: Results of an International Delphi Study

    PubMed Central

    Tomkins-Lane, Christy; Melloh, Markus; Lurie, Jon; Smuck, Matt; Battie, Michele; Freeman, Brian; Samartzis, Dino; Hu, Richard; Barz, Thomas; Stuber, Kent; Schneider, Michael; Haig, Andrew; Schizas, Constantin; Cheung, Jason Pui Yin; Mannion, Anne F.; Staub, Lukas; Comer, Christine; Macedo, Luciana; Ahn, Sang-ho; Takahashi, Kazuhisa; Sandella, Danielle

    2016-01-01

    Study Design Delphi. Objective Obtain an expert consensus on which history factors are most important in the clinical diagnosis of LSS. Summary of Background Data Lumbar spinal stenosis (LSS) is a poorly defined clinical syndrome. Criteria for defining LSS are needed and should be informed by the experience of expert clinicians. Methods Phase 1 (Delphi Items): 20 members of the International Taskforce on the Diagnosis and Management of LSS confirmed a list of 14 history items. An on-line survey was developed that permits specialists to express the logical order in which they consider the items, and the level of certainty ascertained from the questions. Phase 2 (Delphi Study) Round 1: Survey distributed to members of the International Society for the Study of the Lumbar Spine. Round 2: Meeting of 9 members of Taskforce where consensus was reached on a final list of 10 items. Round 3: Final survey was distributed internationally. Phase 3: Final Taskforce consensus meeting. Results 279 clinicians from 29 different countries, with a mean of 19 (±SD: 12) years in practice participated. The six top items were “leg or buttock pain while walking”, “flex forward to relieve symptoms”, “feel relief when using a shopping cart or bicycle”, “motor or sensory disturbance while walking”, “normal and symmetric foot pulses”, “lower extremity weakness” and “low back pain”. Significant change in certainty ceased after 6 questions at 80% (p<.05). Conclusions This is the first study to reach an international consensus on the clinical diagnosis of LSS, and suggests that within six questions clinicians are 80% certain of diagnosis. We propose a consensus-based set of “7 history items” that can act as a pragmatic criterion for defining LSS in both clinical and research settings, which in the long-term may lead to more cost-effective treatment, improved health-care utilization and enhanced patient outcomes. PMID:26839989

  7. Sequence variations in the collagen IX and XI genes are associated with degenerative lumbar spinal stenosis

    PubMed Central

    Noponen-Hietala, N; Kyllonen, E; Mannikko, M; Ilkko, E; Karppinen, J; Ott, J; Ala-Kokko, L

    2003-01-01

    Background: Degenerative lumbar spinal stenosis (LSS) is usually caused by disc herniation or degeneration. Several genetic factors have been implicated in disc disease. Tryptophan alleles in COL9A2 and COL9A3 have been shown to be associated with lumbar disc disease in the Finnish population, and polymorphisms in the vitamin D receptor gene (VDR) (FokI and TaqI), the matrix metalloproteinase-3 gene (MMP-3) and an aggrecan gene (AGC1) VNTR have been reported to be associated with disc degeneration. In addition, an IVS6-4 a>t polymorphism in COL11A2 has been found in connection with stenosis caused by ossification of the posterior longitudinal ligament in the Japanese population. Objective: To study the role of genetic factors in LSS. Methods: 29 Finnish probands were analysed for mutations in the genes coding for intervertebral disc matrix proteins, COL1A1, COL1A2, COL2A1, COL9A1, COL9A2, COL9A3, COL11A1, COL11A2, and AGC1. VDR and MMP-3 polymorphisms were also analysed. Sequence variations were tested in 56 Finnish controls. Results: Several disease associated alleles were identified. A splice site mutation in COL9A2 leading to a premature translation termination codon and the generation of a truncated protein was identified in one proband, another had the Trp2 allele, and four others the Trp3 allele. The frequency of the COL11A2 IVS6-4 t allele was 93.1% in the probands and 72.3% in controls (p = 0.0016). The differences in genotype frequencies for this site were less significant (p = 0.0043). Conclusions: Genetic factors have an important role in the pathogenesis of LSS. PMID:14644861

  8. Complications from the use of intrawound vancomycin in lumbar spinal surgery: a systematic review.

    PubMed

    Ghobrial, George M; Cadotte, David W; Williams, Kim; Fehlings, Michael G; Harrop, James S

    2015-10-01

    OBJECT The use of intrawound vancomycin is rapidly being adopted for the prevention of surgical site infection (SSI) in spinal surgery. At operative closure, the placement of vancomycin powder in the wound bed-in addition to standard infection prophylaxis-can provide high concentrations of antibiotics with minimal systemic absorption. However, despite its popularity, to date the majority of studies on intrawound vancomycin are retrospective, and there are no prior reports highlighting the risks of routine treatment. METHODS A MEDLINE search for pertinent literature was conducted for studies published between 1966 and May 2015 using the following MeSH search terms: "intrawound vancomycin," "operative lumbar spine complications," and "nonoperative lumbar spine complications." This was supplemented with references and known literature on the topic. RESULTS An advanced MEDLINE search conducted on May 6, 2015, using the search string "intrawound vancomycin" found 22 results. After a review of all abstracts for relevance to intrawound vancomycin use in spinal surgery, 10 studies were reviewed in detail. Three meta-analyses were evaluated from the initial search, and 2 clinical studies were identified. After an analysis of all of the identified manuscripts, 3 additional studies were included for a total of 16 studies. Fourteen retrospective studies and 2 prospective studies were identified, resulting in a total of 9721 patients. A total of 6701 (68.9%) patients underwent treatment with intrawound vancomycin. The mean SSI rate among the control and vancomycin-treated patients was 7.47% and 1.36%, respectively. There were a total of 23 adverse events: nephropathy (1 patient), ototoxicity resulting in transient hearing loss (2 patients), systemic absorption resulting in supratherapeutic vancomycin exposure (1 patient), and culture-negative seroma formation (19 patients). The overall adverse event rate for the total number of treated patients was 0.3%. CONCLUSIONS Intrawound

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

    PubMed Central

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

    2014-01-01

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

  10. Nerve cells culture from lumbar spinal cord on surfaces modified by plasma pyrrole polymerization.

    PubMed

    Zuñiga-Aguilar, E; Olayo, R; Ramírez-Fernández, O; Morales, J; Godínez, R

    2014-01-01

    Currently, there are several techniques for modified cell culture surfaces under research to improve cell growth and adhesion. Recently, different methods have been used for surface coating, using biomolecules that enhance cell attachment and growth of nerve cells from spinal cord, such as the use of Poly-DL-Ornithine/Laminin. Plasma-polymerized pyrrole (PPy)-treated surfaces have showed improvement on surfaces biocompatibility with the cells in culture since they do not interfere with any of the biological cell functions. In the present work, we present a novel mouse nerve cell culture technique, using PPy-treated cell culture surfaces. A comparative study of cell survival using Poly-DL-Ornithine/Laminin-treated surfaces was performed. Our results of cell survival when compared with data already reported by other investigators, show that cells cultured on the PPy-modified surface increased survival up to 21 days when compared with Poly-DL-Ornithine/Laminin-coated culture, where 8 days cell survival was obtained. There were electrical and morphological differences in the nerve cells grown in the different surfaces. By comparing the peak ion currents of Poly-DL-Ornithine/Laminin-seeded cells for 8 days with cells grown for 21 days on PPy, an increase of 516% in the Na(+) current and 127% in K(+) currents in cells seeded on PPy were observed. Immunofluorescence techniques showed the presence of cell synapses and culture viability after 21 days. Our results then showed that PPy-modified surfaces are an alternative culture method that increases nerve cells survival from lumbar spinal cord cell culture by preserving its electrical and morphological features.

  11. Spinal manipulation reduces pain and hyperalgesia after lumbar intervertebral foramen inflammation in the rat.

    PubMed

    Song, Xue-Jun; Gan, Qiang; Cao, Jun-Li; Wang, Zheng-Bei; Rupert, Ronald L

    2006-01-01

    To document potential mediating effects of the Activator-assisted spinal manipulative therapy (ASMT) on pain and hyperalgesia after acute intervertebral foramen (IVF) inflammation. The IVF inflammation was mimicked by in vivo delivery of inflammatory soup directly into the L5 IVF in adult male Sprague-Dawley rats. Thermal hyperalgesia and mechanical allodynia were determined by the shortened latency of foot withdrawal to radiant heat and von Frey filament stimulation to the hind paw, respectively. Intracellular recordings were obtained in vitro from L5 dorsal root ganglion (DRG) somata. DRG inflammation was examined by observation of the appearance and hematoxylin and eosin staining. ASMT was applied to the spinous process of L4, L5, and L6. A series of 10 adjustments were initiated 24 hours after surgery and subsequently applied daily for 7 consecutive days and every other day during the second week. (1) ASMT applied on L5, L6, or L5 and L6 spinous process significantly reduced the severity and duration of thermal and mechanical hyperalgesia produced by the IVF inflammation. However, ASMT applied on L4 did not affect the response in rats with IVF inflammation or the controls; (2) electrophysiological studies showed that hyperexcitability of the DRG neurons produced by IVF inflammation was significantly reduced by ASMT; (3) pathological studies showed that manifestations of the DRG inflammation, such as the increased vascularization and satellitosis, were significantly reduced 2 to 3 weeks after ASMT. These studies show that ASMT can significantly reduce the severity and shorten the duration of pain and hyperalgesia caused by lumbar IVF inflammation. This effect may result from ASMT-induced faster elimination of the inflammation and recovery of excitability of the inflamed DRG neurons by improving blood and nutrition supplement to the DRG within the affected IVF. Manipulation of a specific spinal segment may play an important role in optimizing recovery from

  12. Characteristics of Lumbar Disc Herniation With Exacerbation of Presentation Due to Spinal Manipulative Therapy

    PubMed Central

    Huang, Sheng-Li; Liu, Yan-Xi; Yuan, Guo-Lian; Zhang, Ji; Yan, Hong-Wei

    2015-01-01

    Abstract The aim of this article was to delineate the characteristics of lumbar disc herniation (LDH) in patients with exacerbation of symptoms caused by spinal manipulative therapy (SMT). The main emphasis should be on the prevention of this condition by identifying relevant risk factors. Detailed clinico-radiological profiles of a total number of 10 LDH patients with exacerbation of presentation after SMT were reviewed. All the patients underwent neurological and magnetic resonance imaging examinations. Laminectomy and discectomy were performed, and follow-up was carried out in all patients. The duration of symptoms in the patients before SMT was 4–15 years. After the therapy, an acute exacerbation of back and radicular pain was observed within 24 h. Magnetic resonance imaging showed that L4–L5 was the most frequently affected level observed (7 patients), and each patient had a large disc fragment in the spinal canal. The disc fragments were classified into 3 types according to their localizations. The time internal between the exacerbation of presentation and surgery was 23.1 days. No perioperative complications were noted. All the patients were relieved of radicular pain a few days after surgery. During postoperative follow-up, all patients regained the ability to walk; one patient received catheterization for 1 month and another for 6 months. Eight patients reported a complete resolution of presentation and the rest 2 patients were significantly improved. SMT should be prohibited in some LDH patients to prevent neurological damages, in whom there are 5 possible risk factors. Surgical results for these patients are encouraging. PMID:25816037

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2014-01-01

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

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

    PubMed

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

    2016-06-01

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

  16. Cerebral spinal fluid (CSF) collection

    MedlinePlus

    Spinal tap; Ventricular puncture; Lumbar puncture; Cisternal puncture; Cerebrospinal fluid culture ... different ways to get a sample of CSF. Lumbar puncture (spinal tap) is the most common method. ...

  17. Associations between physical therapy and long-term outcomes for individuals with lumbar spinal stenosis in the SPORT study.

    PubMed

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

    2014-08-01

    A period of nonsurgical management is advocated before surgical treatment for most patients with lumbar spinal stenosis. Currently, little evidence is available to define optimal nonsurgical management. Physical therapy is often used, however its use and effectiveness relative to other nonsurgical strategies has not been adequately explored. Describe the use of physical therapy and other nonsurgical interventions by patients with lumbar spinal stenosis and examine the relationship between physical therapy and long-term prognosis. Secondary analysis of the Spine Patient Outcomes Research Trial (SPORT) combining data from randomized and observational studies. Thirteen spine clinics in 11 states in the United States. Patients with lumbar spinal stenosis receiving nonsurgical management including those who did or did not receive physical therapy within 6 weeks of enrollment. Primary outcome measures included crossover to surgery, the bodily pain and physical function scales changes from the Survey Short Form 36 (SF-36), and the modified Oswestry Disability Index. Secondary outcome measures were patient satisfaction and the Sciatica Bothersomeness Index. Baseline characteristics and rates of crossover to surgery were compared between patients who did or did not receive physical therapy. Baseline factors predictive of receiving physical therapy were examined with logistic regression. Mixed effects models were used to compare outcomes between groups at 3 and 6 months and 1 year after enrollment adjusted for baseline severity and patient characteristics. Physical therapy was used in the first 6 weeks by 90 of 244 patients (37%) and was predicted by the absence of radiating pain and being single instead of married. Physical therapy was associated with a reduced likelihood of crossover to surgery after 1 year (21% vs. 33%, p=.045), and greater reductions on the Short Form 36 physical functioning scale after 6 months (mean difference=6.0, 95% confidence interval: 0

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

    PubMed Central

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

    2013-01-01

    Background/Context A period of non-surgical management is advocated prior to surgical treatment for most patients with lumbar spinal stenosis. Currently, little evidence is available to define optimal non-surgical management. Physical therapy is often used, however its use and effectiveness relative to other non-surgical strategies has not been adequately explored. Purpose Describe the utilization of physical therapy and other non-surgical interventions by patients with lumbar spinal stenosis and examine the relationship between physical therapy and long-term prognosis. Study Design Secondary analysis of the Spine Patient Outcomes Research Trial (SPORT) combining data from randomized and observational studies. Setting 13 spine clinics in 11 states in the United States. Patient Sample Patients with lumbar spinal stenosis receiving non-surgical management including those who did or did not receive physical therapy within 6 weeks of enrollment. Outcome Measures Primary outcome measures included cross-over to surgery, the bodily pain and physical function scales changes from the Survey Short Form 36 (SF-36), and the modified Oswestry Disability Index. Secondary outcome measures were patient satisfaction and the Sciatica Bothersomeness Index. Methods Baseline characteristics and rates of cross-over to surgery were compared between patients who did or did not receive physical therapy. Baseline factors predictive of receiving physical therapy were examined with logistic regression. Mixed effects models were used to compare outcomes between groups at 3 and 6 months, and 1 year after enrollment adjusted for baseline severity and patient characteristics. Results Physical therapy was used in the first 6 weeks by 90 of 244 patients (37%) and was predicted by the absence of radiating pain and being single instead of married. Physical therapy was associated with a reduced likelihood of cross-over to surgery after 1 year (21% vs 33%, p=0.045), and greater reductions on the SF-36

  19. Spontaneous healing of retroperitoneal chylous leakage following anterior lumbar spinal surgery: a case report and literature review

    PubMed Central

    Su, I-Chang

    2007-01-01

    Cisterna chyli is prone to injury in any retroperitoneal surgery. However, retroperitoneal chylous leakage is a rare complication after anterior spinal surgery. To the best of our knowledge, only ten cases have been reported in the English literature. We present a case of a 49-year-old man who had lumbar metastasis and associated radiculopathy. He had transient retroperitoneal chylous leakage after anterior tumor decompression, interbody bony fusion, and instrumental fixation from L2 to L4. The leakage stopped spontaneously after we temporarily clamped the drain tube. Intraperitoneal ascites accumulation developed thereafter due to nutritional loss and impaired hepatic reserves. We gathered ten reported cases of chylous leak after anterior thoracolumbar or lumbar spinal surgery, and categorized all these cases into two groups, depending on the integrity of diaphragm. Six patients received anterior spinal surgery without diaphragm splitting. Postoperative chylous leak stopped after conservative treatment. Another five cases received diaphragm splitting in the interim of anterior spinal surgery. Chylous leakage stopped spontaneously in four patients. The remaining one had a chylothorax secondary to postop chyloretroperitoneum. It was resolved only after surgical intervention. In view of these cases, all the chylous leakage could be spontaneously closed without complications, except for one who had a secondary chylothorax and required thoracic duct ligation and chemopleurodesis. We conclude that intraoperative diaphragm splitting or incision does not increase the risk of secondary chylothorax if it was closed tightly at the end of the surgery and the chest tube drainage properly done. PMID:17273839

  20. Spontaneous healing of retroperitoneal chylous leakage following anterior lumbar spinal surgery: a case report and literature review.

    PubMed

    Su, I-Chang; Chen, Chang-Mu

    2007-12-01

    Cisterna chyli is prone to injury in any retroperitoneal surgery. However, retroperitoneal chylous leakage is a rare complication after anterior spinal surgery. To the best of our knowledge, only ten cases have been reported in the English literature. We present a case of a 49-year-old man who had lumbar metastasis and associated radiculopathy. He had transient retroperitoneal chylous leakage after anterior tumor decompression, interbody bony fusion, and instrumental fixation from L2 to L4. The leakage stopped spontaneously after we temporarily clamped the drain tube. Intraperitoneal ascites accumulation developed thereafter due to nutritional loss and impaired hepatic reserves. We gathered ten reported cases of chylous leak after anterior thoracolumbar or lumbar spinal surgery, and categorized all these cases into two groups, depending on the integrity of diaphragm. Six patients received anterior spinal surgery without diaphragm splitting. Postoperative chylous leak stopped after conservative treatment. Another five cases received diaphragm splitting in the interim of anterior spinal surgery. Chylous leakage stopped spontaneously in four patients. The remaining one had a chylothorax secondary to postop chyloretroperitoneum. It was resolved only after surgical intervention. In view of these cases, all the chylous leakage could be spontaneously closed without complications, except for one who had a secondary chylothorax and required thoracic duct ligation and chemopleurodesis. We conclude that intraoperative diaphragm splitting or incision does not increase the risk of secondary chylothorax if it was closed tightly at the end of the surgery and the chest tube drainage properly done.

  1. Elevated levels of phosphorylated neurofilament heavy subunit in the cerebrospinal fluid of patients with lumbar spinal stenosis: preliminary findings.

    PubMed

    Ohya, Junichi; Chikuda, Hirotaka; Kato, So; Hayakawa, Kentaro; Oka, Hiroyuki; Takeshita, Katsushi; Tanaka, Sakae; Ogata, Toru

    2015-07-01

    The phosphorylated neurofilament heavy subunit (pNfH) is an axon fiber structural protein that is released into the cerebrospinal fluid (CSF) after nerve damage. Although the previous studies have reported elevated CSF levels of pNfH in various neurological diseases, including amyotrophic lateral sclerosis, these levels have not been examined in patients with spinal stenosis. The purpose of this study was to investigate the CSF levels of pNfH in patients with lumbar spinal stenosis (LSS) and to examine the relationship between CSF levels of pNfH and the severity of LSS. This is a prospective observational study. We included consecutive patients with LSS who were undergoing myelography for preoperative evaluation. The CSF samples from patients with idiopathic scoliosis were used as the controls. Physiological measures: CSF levels of pNfH were measured using an enzyme-linked immunosorbent assay. The Zurich Claudication Questionnaire (ZCQ) and the Numerical Rating Scale (NRS) for sciatic pain were used to assess the clinical severity of LSS, and patients were grouped into tertiles according to their symptom severity and pain grading. Axial magnetic resonance imaging was used to evaluate the morphological severity of LSS, and patients were classified into three groups based on their morphological grading (using the CSF/rootlet ratio). Analysis of variance was used to examine the relationship between the CSF levels of pNfH and the severity of LSS. Thirty-three patients with LSS were included (13 men and 20 women and mean age 73.2 [range 58-88] years). Most patients (n=32) were positive for pNfH in their CSF (mean 1,344 [149-9,250] pg/mL), whereas all control subjects were negative for pNfH in their CSF. Regarding the association with clinical severity, patients in the third tertiles of ZCQ and NRS tended to have higher levels of pNfH compared with the other groups. There was no association between the CSF level of pNfH and the morphological severity of LSS. This study

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

    PubMed

    Oğuz, Hasan; Levendoğlu, Funda; Oğün, Tunç Cevat; Tantuğ, Aysenur

    2007-07-01

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

  3. Detection of vertebral plateaus in lateral lumbar spinal X-ray images with Gabor filters.

    PubMed

    Alvarez Ribeiro, Eduardo; Nogueira-Barbosa, Marcello Henrique; Rangayyan, Rangaraj M; Azevedo-Marques, Paulo M

    2010-01-01

    A few recent studies have proposed computed-aided methods for the detection and analysis of vertebral bodies in radiographic images. This paper presents a method based on Gabor filters. Forty-one lateral lumbar spinal X-ray images from different patients were included in the study. For each image, a radiologist manually delineated the vertebral plateaus of L1, L2, L3, and L4 using a software tool for image display and mark-up. Each original image was filtered with a bank of 180 Gabor filters. The angle of the Gabor filter with the highest response at each pixel was used to derive a measure of the strength of orientation or alignment. In order to limit the spatial extent of the image data and the derived features in further analysis, a semi-automated procedure was applied to the original image. A neural network utilizing the logistic sigmoid function was trained with pixel intensity from the original image, the result of manual delineation of the plateaus, the Gabor magnitude response, and the alignment image. The average overlap between the results of detection by image processing and manual delineation of the plateaus of L1-L4 in the 41 images tested was 0.917. The results are expected to be useful in the analysis of vertebral deformities and fractures.

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

    PubMed Central

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

    2015-01-01

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

  5. The prevalence and impact of sarcopenia on degenerative lumbar spinal stenosis.

    PubMed

    Park, S; Kim, H J; Ko, B G; Chung, J W; Kim, S H; Park, S H; Lee, M H; Yeom, J S

    2016-08-01

    The purpose of this study was to investigate the prevalence of sarcopenia and to examine its impact on patients with degenerative lumbar spinal stenosis (DLSS). This case-control study included two groups: one group consisting of patients with DLSS and a second group of control subjects without low back or neck pain and related leg pain. Five control cases were randomly selected and matched by age and gender (n = 77 cases and n = 385 controls) for each DLSS case. Appendicular muscle mass, hand-grip strength, sit-to-stand test, timed up and go (TUG) test, and clinical outcomes, including the Oswestry Disability Index (ODI) scores and the EuroQol EQ-5D were compared between the two groups. The prevalence of sarcopenia, as defined by hand-grip strength, was significantly higher in the DLSS group (24%) when compared with the age- and gender-matched control group (12%) (p = 0.004). In the DLSS group, the sarcopenia subgroup demonstrated inferior results for the TUG test and ODI scores when compared with the non-sarcopenia subgroup (p = 0.006 and p = 0.039, respectively) after adjusting for age and gender. This study demonstrated a higher prevalence of sarcopenia in patients with DLSS and highlighted its negative effect on clinical outcomes. Cite this article: Bone Joint J 2016;98-B:1093-8. ©2016 The British Editorial Society of Bone & Joint Surgery.

  6. A comparative analysis of the interpretations of lumbar spinal radiographs by chiropractors and medical doctors.

    PubMed

    Frymoyer, J W; Phillips, R B; Newberg, A H; MacPherson, B V

    1986-12-01

    Ninety-nine anteroposterior and lateral lumbar radiographs taken of men, 18 to 55 years of age, were randomly selected from participants in a population survey of low-back pain. Thirty-one (31%) had never had low-back pain; 44 (44%) had or were having mild low-back pain; and 24 (24%) had or were having severe low-back pain. Three chiropractors assessed 56 radiographic variables, which included determinations of disc space height, vertebral malalignments and subluxations, spondylosis, postural disturbances, relationships among pelvis and spine and other congenital or acquired abnormalities. Interobserver reliability measurements showed that 6 of the 56 variables analyzed produced a high interobserver reliability. Sixteen additional variables showed a fair interobserver reliability. Comparison of the observations made by the chiropractors and a radiologist showed minimal agreement except for disc space height assessments at L3-4 and L4-5. Few of the radiographic variables discriminated between the current or prior history of low-back and leg complaints, although a few variables (most notably disc space narrowing) were statistically associated with back or leg complaints (P = .025). The conclusion was reached that spinal radiographs, whether analyzed by measurements, by a radiologist, or by chiropractors, have minimal value in determining the presence or absence of low-back complaints and, in particular, have no value in epidemiologic studies.

  7. Spinal anaesthesia with adjunctive intrathecal morphine versus continuous lumbar plexus blockade: a randomised comparison for analgesia after hip replacement.

    PubMed

    Fredrickson, M J; Danesh-Clough, T K

    2015-07-01

    Following elective total hip replacement, both continuous lumbar plexus blockade and spinal anaesthesia (with adjunctive intrathecal morphine) have shown early outcome benefits over opioid analgesia and single-injection nerve block. However, the two techniques have not been compared in a prospective randomised manner. Our study examined 50 patients undergoing elective hip joint replacement who were randomised to receive spinal anaesthesia (with adjunctive intrathecal morphine 0.1 mg) or patient-controlled continuous lumbar plexus blockade. All surgery was conducted under general anaesthesia. Measured outcomes included numerically rated postoperative pain, supplemental opioid consumption and indices of mobilisation together with complications. Results show that block placement time was marginally shorter for the spinal group (5 versus 7 minutes, P=0.01). The primary outcome, worst pain on movement/mobilisation during the first 24 hours, was not statistically significantly different between groups. Patients in the lumbar plexus group were given more intraoperative opioid and rescue morphine in the post-anaesthesia care unit (median = 4 versus 0 mg, P <0.001), with correspondingly higher pain scores (median 5/10 versus 0/10, P <0.001). Pain scores during the subsequent 24 hours were similar between groups, but more patients in the spinal group were given rescue morphine (5 versus 0, P=0.02). Physiotherapy mobilisation indices appeared similar between groups. More spinal group patients reported pruritus (12 versus 5, P=0.01), but antiemetic requirements, episodes of disorientation, arterial oxygen desaturation and falls were all similar between groups. Postoperative symptoms suggestive of neurological irritation or injury did not differ between groups. We found that following elective hip joint replacement, compared to continuous lumbar plexus blockade, spinal anaesthesia incorporating adjunctive intrathecal morphine did not result in a statistically significant

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

    PubMed

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

    2016-01-01

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

  9. Impact of post-manipulation corrective core exercises on the spinal deformation and lumbar strength in golfers: a case study.

    PubMed

    Shin, Chul-Ho; Kim, Minjeong; Park, Gi Duck

    2015-09-01

    [Purpose] This study examined spinal shape in professional golfers with chronic back pain, and analyzed the effects of a 4-week regimen of semi-weekly manipulation and corrective core exercises on spinal shape. [Subjects] Two golfers with chronic back pain. [Methods] The pelvis and spinal vertebrae were corrected using the Thompson "drop" technique. Angle and force were adjusted to place the pelvis, lumbar spine, and thoracic vertebrae in neutral position. The technique was applied twice weekly after muscle massage in the back and pelvic areas. The golfers performed corrective, warmup stretching exercises, followed by squats on an unstable surface using the Togu ball. They then used a gym ball for repetitions of hip rotation, upper trunk extension, sit-ups, and pelvic anterior-posterior, pelvic left-right, and trunk flexion-extension exercises. The session ended with cycling as a cool-down exercise. Each session lasted 60 minutes. [Results] The difference in height was measured on the left and right sides of the pelvic bone. The pelvic tilt changed significantly in both participants after the 4-week program. [Conclusion] In golfers, core muscles are critical and are closely related to spinal deformation. Core strengthening and spinal correction play a pivotal role in the correction of spinal deformation.

  10. Impact of post-manipulation corrective core exercises on the spinal deformation and lumbar strength in golfers: a case study

    PubMed Central

    Shin, Chul-ho; Kim, Minjeong; Park, Gi Duck

    2015-01-01

    [Purpose] This study examined spinal shape in professional golfers with chronic back pain, and analyzed the effects of a 4-week regimen of semi-weekly manipulation and corrective core exercises on spinal shape. [Subjects] Two golfers with chronic back pain. [Methods] The pelvis and spinal vertebrae were corrected using the Thompson “drop” technique. Angle and force were adjusted to place the pelvis, lumbar spine, and thoracic vertebrae in neutral position. The technique was applied twice weekly after muscle massage in the back and pelvic areas. The golfers performed corrective, warmup stretching exercises, followed by squats on an unstable surface using the Togu ball. They then used a gym ball for repetitions of hip rotation, upper trunk extension, sit-ups, and pelvic anterior-posterior, pelvic left-right, and trunk flexion-extension exercises. The session ended with cycling as a cool-down exercise. Each session lasted 60 minutes. [Results] The difference in height was measured on the left and right sides of the pelvic bone. The pelvic tilt changed significantly in both participants after the 4-week program. [Conclusion] In golfers, core muscles are critical and are closely related to spinal deformation. Core strengthening and spinal correction play a pivotal role in the correction of spinal deformation. PMID:26504350

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

    PubMed Central

    Cao, Dong-Yuan; Pickar, Joel G.

    2014-01-01

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

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

    PubMed

    Cao, Dong-Yuan; Pickar, Joel G

    2014-06-01

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

  13. Postoperative continuous paravertebral anesthetic infusion for pain control in lumbar spinal fusion surgery.

    PubMed

    Elder, James B; Hoh, Daniel J; Wang, Michael Y

    2008-01-15

    A retrospective, case-control study was conducted to analyze postoperative outcomes in patients who received local anesthetic infusion pumps after lumbar spinal fusion procedures. Data were collected prospectively via nursing protocol and third party assessment, and analyzed retrospectively. To review the safety and efficacy of continuous infusion of local anesthetic into the subfascial aspects of the wound after lumbar fusion surgery for treatment of postoperative pain, and to determine whether other outcome measures such as postoperative nausea and vomiting, ambulation and length of hospitalization were affected by the presence of the device. Patients who undergo lumbar spine fusion procedures frequently experience significant, debilitating pain related to their surgery. This pain may delay postoperative mobilization, increase length of hospitalization, and require prolonged use of high doses of narcotics. Use of a local anesthetic continuous-infusion pump after surgery may lead to improvements in these outcome variables. After posterior lumbar spine fusion procedures, 26 consecutive patients received the ON-Q PainBuster, which infused 0.5% marcaine via an elastomeric pump into the subfascial aspects of the wound. Retrospective analysis compared each of these patients with a case-matched control patient. Data included pain scores and opiate use during the first 5 postoperative days (PODs), length of hospital stay, and complications. Variables such as age, American Society of Anesthesiologists (ASA) physical status, and surgical procedure were similar between matched cases. One patient was excluded because of active heroine abuse. Patients with the ON-Q PainBuster used 41.2% less narcotics on POD 1, 50.1% less on day 2, and 47.1% less on day 3 compared with the control patients. Differences in opiate usage were not statistically significant on POD 4 (45.5% less) and 5 (50.3% less). A lower average pain score was observed among patients with the ON-Q PainBuster on

  14. [Treatment of symptomatic degenerative lumbar spinal stenosis by a percutaneous stand-alone lumbar interspinous implant. Preliminary experience with the Aperius device].

    PubMed

    Collignon, F; Fransen, P

    2010-02-01

    Surgery for degenerative spinal stenosis classically involves decompression by laminectomy or foraminotomy. The use of interspinous process devices has been described for these indications in recent years. This study evaluates the efficacy and morbidity of a percutaneous interspinous device to define whether this technique would be a suitable alternative to classical surgery. Twenty-two patients with degenerative lumbar spinal stenosis were studied prospectively. Pre- and postoperative symptoms were assessed using the Visual Analogic Score (VAS), the Zurich Claudication Questionnaire (ZCQ), physical activity, and patient satisfaction. The implant was positioned under biplanar fluoroscopic control after progressive distraction of the interspinous space using trocars. The patients were reviewed after 7 days, 6 weeks, and 6 months. All patients showed improved gait perimeter: 90 % could walk more than 1000 m 6 months after surgery, whereas only 50 % could walk this distance preoperatively. The mean symptom severity scores of 2.71 and physical activity scores of 2.38 improved to 1.87 (p=0.0003) and 1.53 (p<0.0001), respectively, after 6 months. The VAS decreased 3.5 points (p=0.0008) 6 months after surgery for leg pain. Ninety-one percent of the patients declared they were satisfied with the operation. The Aperius stand-alone and percutaneous interspinous device proved to be effective and safe in treating symptomatic lumbar spinal stenosis. This could be a good alternative to classic decompression surgery, but long-term follow-up studies are needed as well as subgroup analysis to define which patients could benefit from this technique. Copyright 2009 Elsevier Masson SAS. All rights reserved.

  15. Cost-effectiveness of three treatment strategies for lumbar spinal stenosis: Conservative care, laminectomy, and the Superion interspinous spacer

    PubMed Central

    Anderson, Louise H.; Nelson, Teresa; Patel, Vikas V.

    2015-01-01

    Background Lumbar spinal stenosis is a painful and debilitating condition resulting in healthcare costs totaling tens of billions of dollars annually. Initial treatment consists of conservative care modalities such as physical therapy, NSAIDs, opioids, and steroid injections. Patients refractory to these therapies can undergo decompressive surgery, which has good long-term efficacy but is more traumatic and can be associated with high post-operative adverse event (AE) rates. Interspinous spacers have been developed to offer a less-invasive alternative. The objective of this study was to compare the costs and quality adjusted life years (QALYs) gained of conservative care (CC) and decompressive surgery (DS) to a new minimally-invasive interspinous spacer. Methods A Markov model was developed evaluating 3 strategies of care for lumbar spinal stenosis. If initial therapies failed, the model moved patients to more invasive therapies. Data from the Superion FDA clinical trial, a prospective spinal registry, and the literature were used to populate the model. Direct medical care costs were modeled from 2014 Medicare reimbursements for healthcare services. QALYs came from the SF-12 PCS and MCS components. The analysis used a 2-year time horizon with a 3% discount rate. Results CC had the lowest cost at $10,540, while Spacers and DS were nearly identical at about $13,950. CC also had the lowest QALY increase (0.06), while Spacers and DS were again nearly identical (.28). The incremental cost-effectiveness ratios (ICER) for Spacers compared to CC was $16,300 and for DS was $15,200. Conclusions Both the Spacer and DS strategies are far below the commonly cited $50,000/QALY threshold and produced several times the QALY increase versus CC, suggesting that surgical care provides superior value (cost / effectiveness) versus sustained conservative care in the treatment of lumbar spinal stenosis. PMID:26273546

  16. Overexpression of BDNF Increases Excitability of the Lumbar Spinal Network and Leads to Robust Early Locomotor Recovery in Completely Spinalized Rats

    PubMed Central

    Ziemlińska, Ewelina; Kügler, Sebastian; Schachner, Melitta; Wewiór, Iwona; Czarkowska-Bauch, Julita; Skup, Małgorzata

    2014-01-01

    Strategies to induce recovery from lesions of the spinal cord have not fully resulted in clinical applications. This is a consequence of a number of impediments that axons encounter when trying to regrow beyond the lesion site, and that intraspinal rearrangements are subjected to. In the present study we evaluated (1) the possibility to improve locomotor recovery after complete transection of the spinal cord by means of an adeno-associated (AAV) viral vector expressing the neurotrophin brain-derived neurotrophic factor (BDNF) in lumbar spinal neurons caudal to the lesion site and (2) how the spinal cord transection and BDNF treatment affected neurotransmission in the segments caudal to the lesion site. BDNF overexpression resulted in clear increases in expression levels of molecules involved in glutamatergic (VGluT2) and GABAergic (GABA, GAD65, GAD67) neurotransmission in parallel with a reduction of the potassium-chloride co-transporter (KCC2) which contributes to an inhibitory neurotransmission. BDNF treated animals showed significant improvements in assisted locomotor performance, and performed locomotor movements with body weight support and plantar foot placement on a moving treadmill. These positive effects of BDNF local overexpression were detectable as early as two weeks after spinal cord transection and viral vector application and lasted for at least 7 weeks. Gradually increasing frequencies of clonic movements at the end of the experiment attenuated the quality of treadmill walking. These data indicate that BDNF has the potential to enhance the functionality of isolated lumbar circuits, but also that BDNF levels have to be tightly controlled to prevent hyperexcitability. PMID:24551172

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

    PubMed

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

    2017-09-14

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

  18. Lumbar disc herniation and cauda equina syndrome following spinal manipulative therapy: a review of six court decisions in Canada.

    PubMed

    Boucher, Pierre; Robidoux, Sébastien

    2014-02-01

    The purpose of this review is to expand practitioners' knowledge on areas of liability when treating low back pain patients. Six cases where chiropractors in Canada were sued for allegedly causing or aggravating lumbar disc herniation after spinal manipulative therapy were retrieved using the CANLII search database. The case series involves 4 men and 2 women with an average age of 37.3 years (range, 31-48 years). Trial courts' decisions were rendered between 2000 and 2011. This study highlights the following conclusions from Canadian courts: 1) informed consent is an ongoing process that cannot be entirely delegated to office personnel; 2) when the patient's history reveals risk factors for lumbar disc herniation the chiropractor has the duty to rule out disc pathology as an etiology for the symptoms presented by the patients before beginning anything but conservative palliative treatment; 3) lumbar disc herniation may be triggered by spinal manipulative therapy on vertebral segments distant from the involved herniated disc such as the thoracic spine.

  19. Location of Radicular Spinal Arteries in the Lumbar Spine from Analysis of CT Angiograms of the Abdomen and Pelvis.

    PubMed

    Simon, Jeremy I; McAuliffe, Matthew; Smoger, David

    2016-01-01

    Reports of catastrophic neurologic injuries following lumbar transforaminal epidural steroid injections are rare but serious potential complications. The traditional method of performing lumbar transforaminal epidural steroid injections is in the "safe triangle" to avoid contact to the spinal nerve. Some authors advocate an alternative approach by placing the needle inferiorly in a region referred to as "Kambin's triangle" to avoid incurring arteries. This study aimed to determine the location of arteries within the L1-L4 intervertebral foramen in vivo, specifically if they lie within or in close proximity to the "safe triangle" or Kambin's triangle using CT angiograms of the abdomen and pelvis. The authors retrospectively evaluated the location in vivo of arterial vessels in the intervertebral foramen from L1 to L4 in patients who underwent abdominopelvic CT angiograms for aortic vascular disease. The data were reanalyzed to confirm inter-rater reliability. Arteries were found in both the safe triangle and Kambin's triangle at a statistically significant rate (P < 0.05). In this group of patients, an artery was found in either the safe triangle or in Kambin's triangle frequently, suggesting the location of these arteries can be quite variable. Physicians performing these procedures should use universal precautions to avoid inadvertent injection into the lumbar spinal arteries and minimize potential complications regardless of the approach. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. 2016. This work is written by US Government employees and is in the public domain in the US.

  20. [Posterior interbody fusion versus improved transforaminal lumbar interbody fusion in segmental spinal fixation for aged spondylolisthesis with lumbar spinal canal stenosis].

    PubMed

    Ma, Chao; Wu, Ji-bin; Zhao, Meng; Dai, Wei-xiang; Wu, De-hui; Wang, Zhao-hong; Feng, Jie; Liu, Chao; Zhao, Qing-hua; Tian, Ji-wei

    2012-03-06

    To assess the clinical and radiographic outcomes of posterior lumbar fixation and posterior interbody fusion or improved transforaminal lumbar interbody fusion for Meyerding grade II/III spondylolisthesis so as to address the suitability of a dynamic stabilization. A total of 28 consecutive patients underwent posterior lumbar fixation and posterior interbody fusion or improved transforaminal lumbar interbody fusion for Meyerding grade II/III spondylolisthesis. Among them, 13 patients underwent posterior interface fusion (PLIF) and pedicle screw fixation. And improved transforaminal lumbar interbody fusion (ITLIF) and placement of the same system were performed in 15 patients. Their clinical, economic, functional, and radiographic data were recorded both pre- and postoperatively. The average changes of economic and functional scores on the Prolo scale were 1.36 and 1.48 respectively. In patients with posterior interbody fusion; the average preoperative vertebral slippage was 46.9% (range: 25 - 75%) versus 14.6% (range: 15 - 25%) postoperatively. In patients with ITLIF, the average changes in economic and functional scores were 1.75 and 1.63 respectively. And the average preoperative vertebral slippage was 45.2% (range: 28 - 78%) compared with 26.3% (range: 14 - 28%) postoperatively. When two fusion techniques were compared, an overall superior reliability and resistance of systems was associated with the ITLIF procedure. But their clinical outcomes did not differ greatly (P > 0.05). The application of a segmental pedicle screw fixation is both feasible and efficacious.

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

    NASA Astrophysics Data System (ADS)

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

    To investigate mechanisms of hypogravity motor syndrome development the immunoexpression of heat shock proteins (Hsp27 and Hsp70), proteins of synaptic transmission (Synaptophysin and PSD95) and neuroprotective proteins (VEGF and Flt-1) in motoneurons of lumbar spinal cord in c57black/6 control mice (n=2) and after 30-days space flight (n=2) was studied. For a quantitative assessment of target proteins level in motoneurons frozen cross sections of lumbar spinal cord were underwent to immunohistochemical staining. Primary antibodies against VEGF, Flt-1, Hsp27 and Hsp70 (SantaCruz Biotechnology, inc. USA), against Synaptophysin and PSD95 (Abcam plc, UK) were visualized by streptavidin-biotin method. Images of spinal cords were received using OlympusBX51WI microscope with AxioCamMRm camera (CarlZeiss, Germany) and the AxioVisionRel. 4.6.3 software (CarlZeiss, Germany). The digitized data were analyzed using ImageJ 1.43 software (NIH, the USA). Quantitively, protein level in motoneurons was estimated by the density of immunoprecipitation. Results of research have not revealed any reliable changes in the immunnoexpression of vascular endothelial growth factor (VEGF) and its Flt-1 receptor in motoneurons of lumbar spinal cord in control and in mice after 30-day space flight. Studying of heat shock proteins, such as Hsp27 and Hsp70, revealed the decrease in level of these proteins immunoexpression in motoneurons of mice from flight group by 15% and 10%, respectively. Some decrease in level of immunnoexpression of presynaptic membrane proteins (synaptophysin, by 21%) and proteins of postsynaptic area (PSD95, by 55%) was observed after space flight. The data obtained testify to possible changes in a functional state (synaptic activity and stress resistance) of motoneurons of lumbar spinal cord in mice after space flight. Thus, we obtained new data on involvement of motoneurons innervating skeletal muscles in development of hypogravity motor syndrome. Research was supported

  2. The impact of incidental durotomy on the outcome of decompression surgery in degenerative lumbar spinal canal stenosis: analysis of the Lumbar Spinal Outcome Study (LSOS) data--a Swiss prospective multi-center cohort study.

    PubMed

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

    2016-04-18

    Incidental durotomy is a well-known complication during surgery for degenerative lumbar spinal stenosis (DLSS). In this prospective multicenter cohort study including eight medical centers our aim was to assess whether incidental durotomy during first-time lumbar spinal stenosis decompression surgery without fusion has an impact on long-term outcome. Patients of the multi-center Lumbar Stenosis Outcome Study (LSOS) with confirmed DLSS undergoing first-time decompression without fusion were enrolled in this study. Baseline patient characteristics and outcomes were analyzed at 6, 12, and 24 months follow-up respectively with the Spinal Stenosis Measure (SSM), the Numeric Rating Scale (NRS), Feeling Thermometer (FT), the EQ-5D-EL, and the Roland and Morris Disability Questionnaire (RMDQ). A total of 167 patients met the inclusion criteria. Fifteen (9%) of those patients had an incidental durotomy. Baseline characteristics were similar between the durotomy and no-durotomy group. All patients improved over time. In the group of durotomy patients, the median improvement in SSM symptoms scale was 1.1 points at 6 months, 1.1 points at 12 months, and 1.6 points at 24 months after baseline. For the no-durotomy group, these improvements were 0.8, 0.9, and 0.9. For SSM function the improvements were 1.0, 0.8, and 0.9 in the durotomy group, and 0.6, 0.8, and 0.8 in the no-durotomy group. None of the between-group differences were statistically significant. Incidental durotomy in patients with DLSS undergoing first-time decompression surgery without fusion did not have negative effect on long-term outcome and quality of life. However, only 15 patients were included in the durotomy group but these findings remained even after adjusting for observed differences in baseline characteristics.

  3. Somatotopic organization of lumbar muscle-innervating neurons in the ventral horn of the rat spinal cord.

    PubMed

    Takahashi, Yuzuru; Ohtori, Seiji; Takahashi, Kazuhisa

    2010-04-01

    The ventral horn of the rat spinal cord was investigated with respect to the somatotopic organization of the motor neurons that innervate the lumbar muscles. Neurotracer 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate (DiI) was applied to specific sites in lumbar muscles. Spinal cord segments at L1 through L4 levels were cut into 40-mum serial transverse sections. Labeled neurons were located in the ventromedial nucleus (VM) and lateromedial nucleus (LM) nuclei of Rexed's lamina IX. Motor neurons innervating the m. interspinales lumborum and m. multifidus were without exception present in the VM, whereas all motor neurons innervating the m. rectus abdominis were present in the LM. Forty percent of motor neurons innervating the m. quadratus lumborum were present in the VM and the other 60% were in the LM. Although most of the motor neurons innervating the m. psoas major were present in the LM, a few labeled neurons existed in the VM. These results suggest that the border zone demarcating the areas of innervation of the dorsal and ventral rami of spinal nerves crosses the m. quadratus lumborum.

  4. Extensive ischemic brainstem lesions and pneumocephalus after application of hydrogen peroxide (H2O2) during lumbar spinal surgery.

    PubMed

    Kleffmann, Jens; Ferbert, Andreas; Deinsberger, Wolfgang; Roth, Christian

    2015-04-01

    The hemostatic properties of hydrogen peroxide (H2O2) are often used in neurosurgical practice. We present the case of an 81-year-old woman who underwent lumbar spinal surgery (microsurgical decompression) in an external hospital. H2O2 was used during the procedure. The patient was transferred to our hospital. She remained unconscious postoperatively, with progressive loss of brainstem reflexes. Computed tomography showed intra- and extradurally trapped air ascending from the operated lumbar segment up to frontal lobe. Magnetic resonance imaging demonstrated severe brainstem lesions on T2- and diffusion-weighted series. The patient died 10 days after surgery. Autopsy was not performed. Our case demonstrates a fatal complication with ischemic brainstem lesions and pneumocephalus after the use of hydrogen peroxide. Therefore, H2O2 should only be used in cases without any signs of dural injury. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. A Multi-center Clinical Study of Posterior Lumbar Interbody Fusion with the Expandable Stand-alone Cage (Tyche® Cage) for Degenerative Lumbar Spinal Disorders

    PubMed Central

    Kim, Jin Wook; Yoon, Seung Hwan; Oh, Seong Hoon; Roh, Sung Woo; Rim, Dae Cheol; Kim, Tae Sung

    2007-01-01

    Objective This multi-center clinical study was designed to determine the long-term results of patients who received a one-level posterior lumbar interbody fusion with expandable cage (Tyche® cage) for degenerative spinal diseases during the same period in each hospital. Methods Fifty-seven patients with low back pain who had a one-level posterior lumbar interbody fusion using a newly designed expandable cage were enrolled in this study at five centers from June 2003 to December 2004 and followed up for 24 months. Pain improvement was checked with a Visual Analogue Scale (VAS) and their disability was evaluated with the Oswestry Disability Index. Radiographs were obtained before and after surgery. At the final follow-up, dynamic stability, quality of bone fusion, interveretebral disc height, and lumbar lordosis were assessed. In some cases, a lumbar computed tomography scan was also obtained. Results The mean VAS score of back pain was improved from 6.44 points preoperatively to 0.44 at the final visit and the score of sciatica was reduced from 4.84 to 0.26. Also, the Oswestry Disability Index was improved from 32.62 points preoperatively to 18.25 at the final visit. The fusion rate was 92.5%. Intervertebral disc height, recorded as 9.94±2.69 mm before surgery was increased to 12.23±3.31 mm at postoperative 1 month and was stabilized at 11.43±2.23 mm on final visit. The segmental angle of lordosis was changed significantly from 3.54±3.70° before surgery to 6.37±3.97° by 24 months postoperative, and total lumbar lordosis was 20.37±11.30° preoperatively and 24.71±11.70° at 24 months postoperative. Conclusion There have been no special complications regarding the expandable cage during the follow-up period and the results of this study demonstrates a high fusion rate and clinical success. PMID:19096552

  6. 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.

  7. Dura-arachnoid lesions produced by 22 gauge Quincke spinal needles during a lumbar puncture

    PubMed Central

    Reina, M; Lopez, A; Badorrey, V; De Andres, J A; Martin, S

    2004-01-01

    Aims: The dural and arachnoid hole caused by lumbar puncture needles is a determining factor in triggering headaches. The aim of this study is to assess the dimensions and morphological features of the dura mater and arachnoids when they are punctured by a 22 gauge Quincke needle having its bevel either in the parallel or in the transverse position. Methods: Fifty punctures were made with 22 gauge Quincke needles in the dural sac of four fresh cadavers using an "in vitro" model especially designed for this purpose. The punctures were performed by needles with bevels parallel or perpendicular to the spinal axis and studied under scanning electron microscopy. Results: Thirty five of the 50 punctures done by Quincke needles (19 in the external surface and 16 in the internal) were used for evaluation. When the needle was inserted with its bevel parallel to the axis of the dural sac (17 of 35), the size of the dura-arachnoid lesion was 0.032 mm2 in the epidural surface and 0.037 mm2 in the subarachnoid surface of the dural sac. When the needle's bevel was perpendicular to the axis (18 of 35) the measurement of the lesion size was 0.042 mm2 for the external surface and 0.033 mm2 for the internal. There were no statistical significant differences between these results. Conclusions: It is believed that the reported lower frequency of postdural puncture headache when the needle is inserted parallel to the cord axis should be explained by some other factors besides the size of the dura-arachnoid injury. PMID:15146008

  8. Clinical outcomes of microendoscopic decompressive laminotomy for degenerative lumbar spinal stenosis.

    PubMed

    Pao, Jwo-Luen; Chen, Wein-Chin; Chen, Po-Quang

    2009-05-01

    The goal of surgical treatment for degenerative lumbar spinal stenosis (LSS) is to effectively relieve the neural structures by various decompressive techniques. Microendoscopic decompressive laminotomy (MEDL) is an attractive option because of its minimally invasive nature. The aim of prospective study was to investigate the effectiveness of MEDL by evaluating the clinical outcomes with patient-oriented scoring systems. Sixty consecutive patients receiving MEDL between December 2005 and April 2007 were enrolled. The indications of surgery were moderate to severe stenosis, persistent neurological symptoms, and failure of conservative treatment. The patients with mechanical back pain, more than grade I spondylolisthesis, or radiographic signs of instability were not included. A total of 53 patients (36 women and 17 men, mean age 62.0) were included. Forty-five patients (84.9%) were satisfied with the treatment result after a follow-up period of 15.7 months (12-24). The clinical outcomes were evaluated with the Oswestry disability index (ODI) and the Japanese Orthopedic Association (JOA) score. Of the 50 patients providing sufficient data for analysis, the ODI improved from 64.3 +/- 20.0 to 16.7 +/- 20.0. The JOA score improved from 9.4 +/- 6.1 to 24.2 +/- 6.0. The improvement rate was 73.9 +/- 30.7% and 40 patients (80%) had good or excellent results. There were 11 surgical complications: dural tear in 5, wrong level operation in 2, and transient neuralgia in 4 patients. No wound-related complication was noted. Although the prevalence of pre-operative comorbidities was very high (69.8%), there was no serious medical complication. There was no post-operative instability at the operated segment as evaluated with dynamic radiographs at final follow-up. We concluded that MEDL is a safe and very effective minimally invasive technique for degenerative LSS. With an appropriate patient selection, the risk of post-operative instability is minimal.

  9. Chiropractic spinal manipulation and the risk for acute lumbar disc herniation: a belief elicitation study.

    PubMed

    Hincapié, Cesar A; Cassidy, J David; Côté, Pierre; Rampersaud, Y Raja; Jadad, Alejandro R; Tomlinson, George A

    2017-09-18

    Chiropractic spinal manipulation treatment (SMT) is common for back pain and has been reported to increase the risk for lumbar disc herniation (LDH), but there is no high quality evidence about this. In the absence of good evidence, clinicians can have knowledge and beliefs about the risk. Our purpose was to determine clinicians' beliefs regarding the risk for acute LDH associated with chiropractic SMT. Using a belief elicitation design, 47 clinicians (16 chiropractors, 15 family physicians and 16 spine surgeons) that treat patients with back pain from primary and tertiary care practices were interviewed. Participants' elicited incidence estimates of acute LDH among a hypothetical group of patients with acute low back pain treated with and without chiropractic SMT, were used to derive the probability distribution for the relative risk (RR) for acute LDH associated with chiropractic SMT. Chiropractors expressed the most optimistic belief (median RR 0.56; IQR 0.39-1.03); family physicians expressed a neutral belief (median RR 0.97; IQR 0.64-1.21); and spine surgeons expressed a slightly more pessimistic belief (median RR 1.07; IQR 0.95-1.29). Clinicians with the most optimistic views believed that chiropractic SMT reduces the incidence of acute LDH by about 60% (median RR 0.42; IQR 0.29-0.53). Those with the most pessimistic views believed that chiropractic SMT increases the incidence of acute LDH by about 30% (median RR 1.29; IQR 1.11-1.59). Clinicians' beliefs about the risk for acute LDH associated with chiropractic SMT varied systematically across professions, in spite of a lack of scientific evidence to inform these beliefs. These probability distributions can serve as prior probabilities in future Bayesian analyses of this relationship.

  10. Physical therapy interventions for degenerative lumbar spinal stenosis: a systematic review.

    PubMed

    Macedo, Luciana Gazzi; Hum, Abraham; Kuleba, Laura; Mo, Joey; Truong, Linda; Yeung, Mankeen; Battié, Michele C

    2013-12-01

    Physical therapy is commonly prescribed for patients with lumbar spinal stenosis (LSS); however, little is known about its effectiveness. The purpose of this study was to systematically review randomized controlled trials (RCTs), controlled trials, and cohort studies evaluating the effectiveness of physical therapy for LSS. Studies were searched on electronic databases to January 2012. Inclusion criteria were: clinical diagnosis of LSS with confirmatory imaging, evaluation of physical therapy treatment, presence of a comparison group, and outcomes of pain, disability, function, or quality of life. Outcomes were extracted and, when possible, pooled using RevMan 5, a freely available review program from the Cochrane Library. Ten studies were included: 5 RCTs, 2 controlled trials, 2 mixed-design studies, and 1 longitudinal cohort study. Pooled effects of 2 studies revealed that the addition of a physical therapy modality to exercise had no statistically significant effect on outcome. Pooled effects results of RCTs evaluating surgery versus physical therapy demonstrated that surgery was better than physical therapy for pain and disability at long term (2 years) only. Other results suggested that exercise is significantly better than no exercise, that cycling and body-weight-supported treadmill walking have similar effects, and that corsets are better than no corsets. The limitations of this review include the low quality and small number of studies, as well as the heterogeneity in outcomes and treatments. No conclusions could be drawn from the review regarding which physical therapy treatment is superior for LSS. There was low-quality evidence suggesting that modalities have no additional effect to exercise and that surgery leads to better long-term (2 years) outcomes for pain and disability, but not walking distance, than physical therapy in patients with LSS.

  11. Physical Therapy Interventions for Degenerative Lumbar Spinal Stenosis: A Systematic Review

    PubMed Central

    Macedo, Luciana Gazzi; Hum, Abraham; Kuleba, Laura; Mo, Joey; Truong, Linda; Yeung, Mankeen

    2013-01-01

    Background Physical therapy is commonly prescribed for patients with lumbar spinal stenosis (LSS); however, little is known about its effectiveness. Purpose The purpose of this study was to systematically review randomized controlled trials (RCTs), controlled trials, and cohort studies evaluating the effectiveness of physical therapy for LSS. Data Sources Studies were searched on electronic databases to January 2012. Study Selection Inclusion criteria were: clinical diagnosis of LSS with confirmatory imaging, evaluation of physical therapy treatment, presence of a comparison group, and outcomes of pain, disability, function, or quality of life. Data Extraction Outcomes were extracted and, when possible, pooled using RevMan 5, a freely available review program from the Cochrane Library. Data Synthesis Ten studies were included: 5 RCTs, 2 controlled trials, 2 mixed-design studies, and 1 longitudinal cohort study. Pooled effects of 2 studies revealed that the addition of a physical therapy modality to exercise had no statistically significant effect on outcome. Pooled effects results of RCTs evaluating surgery versus physical therapy demonstrated that surgery was better than physical therapy for pain and disability at long term (2 years) only. Other results suggested that exercise is significantly better than no exercise, that cycling and body-weight–supported treadmill walking have similar effects, and that corsets are better than no corsets. Limitations The limitations of this review include the low quality and small number of studies, as well as the heterogeneity in outcomes and treatments. Conclusions No conclusions could be drawn from the review regarding which physical therapy treatment is superior for LSS. There was low-quality evidence suggesting that modalities have no additional effect to exercise and that surgery leads to better long-term (2 years) outcomes for pain and disability, but not walking distance, than physical therapy in patients with LSS. PMID

  12. Relationship between ambulatory performance and self-rated disability in patients with lumbar spinal stenosis.

    PubMed

    Pryce, Rob; Johnson, Michael; Goytan, Michael; Passmore, Steven; Berrington, Neil; Kriellaars, Dean

    2012-07-01

    A cross-sectional study. To identify the relationship between performance measures derived from accelerometry and subjective reports of pain, disability, and health in patients with lumbar spinal stenosis (LSS). Accelerometers have emerged as a measure of performance, providing the ability to characterize the pattern and magnitude of real-life activity, and sedentarism. Pain and loss of function, particularly ambulation, are common in LSS. The extent to which pain, perceived disability, and self-rated health relate to performance in patients with LSS is not well known. Data regarding self-reported pain, disability (Oswestry Disability Index, Roland-Morris Disability Questionnaire, and Disabilities of the Arm, Shoulder, and Hand), and health (36-Item Short Form Health Survey [SF-36]) were collected from patients with LSS (n = 33). Physical activity, ambulation, and inactivity performance measures were derived from 7-day accelerometer records. Correlation and stepwise regression were used. The physical function subscale of the SF-36, a non-pathology-specific outcome, had the best overall correlation to physical activity and ambulation (average r = 0.53) compared with pain (average r = 0.32) and disability (average r = -0.45) outcomes. Stepwise regression models for performance were predominantly single-variable models (4 of 8 models); pain was not selected as a predictor. A second non-pathology-specific outcome, the Disabilities of Arm Shoulder and Hand, improved the prediction of performance in 5 of 8 models. Subjective measures of pain and disability had limited ability to account for real-life performance in patients with LSS. Future research is required to identify determinants of performance in patients with LSS because barriers to activity may not be disease-specific.

  13. Preoperative Embolization of Hypervascular Thoracic, Lumbar, and Sacral Spinal Column Tumors: Technique and Outcomes from a Single Center

    PubMed Central

    Nair, Sreejit; Gobin, Y. Pierre; Leng, Lewis Z.; Marcus, Joshua D.; Bilsky, Mark; Laufer, Ilya; Patsalides, Athos

    2013-01-01

    Summary The existing literature on preoperative spine tumor embolization is limited in size of patient cohorts and diversity of tumor histologies. This report presents our experience with preoperative embolization of hypervascular thoracic, lumbar, and sacral spinal column tumors in the largest series to date. We conducted a retrospective review of 228 angiograms and 188 pre-operative embolizations for tumors involving thoracic, lumbar and sacral spinal column. Tumor vascularity was evaluated with conventional spinal angiography and was graded from 0 (same as normal adjacent vertebral body) to 3 (severe tumor blush with arteriovenous shunting). Embolic materials included poly vinyl alcohol (PVA) particles and detachable platinum coils and rarely, liquid embolics. The degree of embolization was graded as complete, near-complete, or partial. Anesthesia records were reviewed to document blood loss during surgery. Renal cell carcinoma (44.2%), thyroid carcinoma (9.2%), and leiomyosarcoma (6.6%) were the most common tumors out of a total of 40 tumor histologies. Hemangiopericytoma had the highest mean vascularity (2.6) of all tumor types with at least five representative cases followed by renal cell carcinoma (2.0) and thyroid carcinoma (2.0). PVA particles were used in 100% of cases. Detachable platinum coils were used in 51.6% of cases. Complete, near-complete, and partial embolizations were achieved in 86.1%, 12.7%, and 1.2% of all cases, respectively. There were no new post-procedure neurologic deficits or other complications with long-term morbidity. The mean intra-operative blood loss for the hypervascular tumors treated with pre-operative embolization was 1745 cc. Preoperative embolization of hypervascular thoracic, lumbar, and sacral spine tumors can be performed with high success rates and a high degree of safety at high volume centers. PMID:24070089

  14. Clinical values of control over pain and pain coping strategies in surgical treatment for patients with lumbar spinal stenosis

    PubMed Central

    2016-01-01

    Background Control over pain and pain coping strategies are associated with pain intensity as well as psychological status and subjective disability in patients experiencing pain. The present study assessed the clinical values of control over pain and pain coping strategies in surgical treatment for patients with lumbar spinal stenosis using mediation analysis. Methods Sixty-two patients with lumbar spinal stenosis (median age, 70 years; 34 men, 28 women) were evaluated before surgery. The pain intensity and area, psychological status/subjective disability (Japanese Orthopaedic Association Back Pain Evaluation Questionnaire), and control over pain/pain coping strategies (Coping Strategies Questionnaire) were assessed. Mediation analysis, which consisted of serial regression analyses, mainly tested whether (1) control over pain/pain coping strategies were predicted by pain characteristics and (2) control over pain/pain coping strategies predicted psychological status/subjective disability after controlling for pain characteristics. Results Control over pain was predicted by pain intensity (regression coefficient, -0.33; p = 0.01); moreover, it predicted walking ability (standardized partial regression coefficient, 0.31; p = 0.01) and social function (0.38; p = 0.00) after controlling for pain intensity. Although increasing activity level, one pain coping strategy, was predicted by pain intensity (regression coefficient, -0.30; p = 0.02), it did not predict walking ability (standardized partial regression coefficient, 0.07; p = 0.53) or social function (0.13; p = 0.33) when considering pain intensity. Conclusions In this cohort, mediation analysis demonstrated that pain intensity did not directly affect perceived walking ability or social function, but did affect control over pain; moreover, control over pain affected walking ability and social function. Clinical relevance These findings are useful for a deep understanding of the relationships between pain and

  15. Preoperative embolization of hypervascular thoracic, lumbar, and sacral spinal column tumors: technique and outcomes from a single center.

    PubMed

    Nair, Sreejit; Gobin, Y Pierre; Leng, Lewis Z; Marcus, Joshua D; Bilsky, Mark; Laufer, Ilya; Patsalides, Athos

    2013-09-01

    The existing literature on preoperative spine tumor embolization is limited in size of patient cohorts and diversity of tumor histologies. This report presents our experience with preoperative embolization of hypervascular thoracic, lumbar, and sacral spinal column tumors in the largest series to date. We conducted a retrospective review of 228 angiograms and 188 pre-operative embolizations for tumors involving thoracic, lumbar and sacral spinal column. Tumor vascularity was evaluated with conventional spinal angiography and was graded from 0 (same as normal adjacent vertebral body) to 3 (severe tumor blush with arteriovenous shunting). Embolic materials included poly vinyl alcohol (PVA) particles and detachable platinum coils and rarely, liquid embolics. The degree of embolization was graded as complete, near-complete, or partial. Anesthesia records were reviewed to document blood loss during surgery. Renal cell carcinoma (44.2%), thyroid carcinoma (9.2%), and leiomyosarcoma (6.6%) were the most common tumors out of a total of 40 tumor histologies. Hemangiopericytoma had the highest mean vascularity (2.6) of all tumor types with at least five representative cases followed by renal cell carcinoma (2.0) and thyroid carcinoma (2.0). PVA particles were used in 100% of cases. Detachable platinum coils were used in 51.6% of cases. Complete, near-complete, and partial embolizations were achieved in 86.1%, 12.7%, and 1.2% of all cases, respectively. There were no new post-procedure neurologic deficits or other complications with long-term morbidity. The mean intra-operative blood loss for the hypervascular tumors treated with pre-operative embolization was 1745 cc. Preoperative embolization of hypervascular thoracic, lumbar, and sacral spine tumors can be performed with high success rates and a high degree of safety at high volume centers.

  16. Stereotactic radiotherapy for spinal intradural metastases developing within or adjacent to the previous irradiation field--report of three cases.

    PubMed

    Mori, Yoshimasa; Hashizume, Chisa; Shibamoto, Yuta; Kobayashi, Tatsuya; Nakazawa, Hisato; Hagiwara, Masahiro; Tsugawa, Takahiko

    2013-08-01

    Results of stereotactic radiotherapy (SRT) for spinal intradural metastases developing inside or adjacent to the previous external-beam radiation therapy (EBRT) field are shown in 3 cases. One case of spinal intramedullary metastasis and two cases of intradural extramedullary metastases were treated using a Novalis shaped-beam SRT. Case 1 developed an intramedullary metastatic tumor in the C1 spinal medulla inside the previous whole brain EBRT field and another lesion adjacent to the field in the C2 spinal medulla. Case 2 developed intradural extramedullary metastasis around C6-8 inside the previous EBRT field for the primary lung adenocarcinoma. Case 3 developed multiple spinal intradural extramedullary metastatic deposits after surgical resection and following whole brain EBRT for brain metastasis. We delivered 24 to 36 Gy in 5 to 12 fractions. The treated tumors were stable or decreased in size until the patients' death from the primary cancer (10, 22, and 5 months). Neurological symptoms were stable or improved in all 3 patients. Palliative SRT using Novalis is expected to be safe and effective even if the patient develops spinal intradural metastases within or adjacent to the previous irradiation field.

  17. The Memory Metal Spinal System in a Posterior Lumbar Interbody Fusion (PLIF) Procedure: A Prospective, Non-Comparative Study to Evaluate the Safety and Performance.

    PubMed

    Kok, D; Grevitt, M; Wapstra, Fh; Veldhuizen, Ag

    2012-01-01

    A prospective, non-comparative study of 27 patients to evaluate the safety and performance of the Memory Metal Spinal System used in a PLIF procedure in the treatment of spondylolisthesis, symptomatic spinal stenosis or degenerative disc disease (DDD). To evaluate the clinical performance, radiological outcome and safety of the Memory Metal Spinal System, used in a PLIF procedure, in the treatment of spondylolisthesis, symptomatic spinal stenosis or degenerative disc disease in human subjects. Spinal systems that are currently available for correction of spinal deformities or degeneration such as lumbar spondylosis or degenerative disc disease, use components manufactured from stainless steel or titanium and typically comprise two spinal rods with associated connection devices. The Memory Metal Spinal System consists of a single square spinal rod made from a nickel titanium alloy (Nitinol) used in conjunction with connection devices. Nitinol is characterized by its shape memory effect and is a more flexible material than either stainless steel or titanium. With current systems there is loss of achieved reposition due to the elastic properties of the spine. By using a memory metal in this new system the expectation was that this loss of reposition would be overcome due to the metal's inherent shape memory properties. Furthermore, we expect a higher fusion rate because of the elastic properties of the memory metal. Twenty-seven subjects with primary diagnosis of spondylolisthesis, symptomatic spinal stenosis or degenerative disc disease (DDD) were treated with the Memory Metal Spinal System in conjunction with the Brantigan IF® Cage in two consecutive years. Clinical performance of the device was evaluated over 2 years using the Oswestry Disability Index (ODI), Short Form 36 questionnaire (SF-36) and pain visual analogue scale (VAS) scores. Safety was studied by collection of adverse events intra-operative and during the followup. Interbody fusion status was

  18. The Memory Metal Spinal System in a Posterior Lumbar Interbody Fusion (PLIF) Procedure: A Prospective, Non-Comparative Study to Evaluate the Safety and Performance

    PubMed Central

    Kok, D; Grevitt, M; Wapstra, FH; Veldhuizen, AG

    2012-01-01

    Study Design: A prospective, non-comparative study of 27 patients to evaluate the safety and performance of the Memory Metal Spinal System used in a PLIF procedure in the treatment of spondylolisthesis, symptomatic spinal stenosis or degenerative disc disease (DDD). Objective: To evaluate the clinical performance, radiological outcome and safety of the Memory Metal Spinal System, used in a PLIF procedure, in the treatment of spondylolisthesis, symptomatic spinal stenosis or degenerative disc disease in human subjects. Summary of Background Data: Spinal systems that are currently available for correction of spinal deformities or degeneration such as lumbar spondylosis or degenerative disc disease, use components manufactured from stainless steel or titanium and typically comprise two spinal rods with associated connection devices. The Memory Metal Spinal System consists of a single square spinal rod made from a nickel titanium alloy (Nitinol) used in conjunction with connection devices. Nitinol is characterized by its shape memory effect and is a more flexible material than either stainless steel or titanium. With current systems there is loss of achieved reposition due to the elastic properties of the spine. By using a memory metal in this new system the expectation was that this loss of reposition would be overcome due to the metal’s inherent shape memory properties. Furthermore, we expect a higher fusion rate because of the elastic properties of the memory metal. Methods: Twenty-seven subjects with primary diagnosis of spondylolisthesis, symptomatic spinal stenosis or degenerative disc disease (DDD) were treated with the Memory Metal Spinal System in conjunction with the Brantigan IF® Cage in two consecutive years. Clinical performance of the device was evaluated over 2 years using the Oswestry Disability Index (ODI), Short Form 36 questionnaire (SF-36) and pain visual analogue scale (VAS) scores. Safety was studied by collection of adverse events intra

  19. Effect of foot movement and an elastic lumbar back support on spinal loading during free-dynamic symmetric and asymmetric lifting exertions.

    PubMed

    Marras, W S; Jorgensen, M J; Davis, K G

    2000-05-01

    The aim of this study was to assess the effect of an elastic lumbar back support on spinal loading and trunk, hip and knee kinematics while allowing subjects to move their feet during lifting exertions. Predicted spinal forces and moments about the L5/S1 intervertebral disc from a three-dimensional EMG-assisted biomechanical model, trunk position, velocities and accelerations, and hip and knee angles were evaluated as a function of wearing an elastic lumbar back support, while lifting two different box weights (13.6 and 22.7 kg) from two different heights (knee and 10 cm above knee height), and from two different asymmetries at the start of the lift (sagittally symmetric and 60 degrees asymmetry). Subjects were allowed to lift using any lifting style they preferred, and were allowed to move their feet during the lifting exertion. Wearing a lumbar back support resulted in no significant differences for any measure of spinal loading as compared with the no-back support condition. However, wearing a lumbar back support resulted in a modest but significant decrease in the maximum sagittal flexion angle (36.5 to 32.7 degrees), as well as reduction in the sagittal trunk extension velocity (47.2 to 40.2 degrees s(-1)). Thus, the use of the elastic lumbar back support provided no protective effect regarding spinal loading when individuals were allowed to move their feet during a lifting exertion.

  20. Treadmill training induced lumbar motoneuron dendritic plasticity and behavior recovery in adult rats after a thoracic contusive spinal cord injury.

    PubMed

    Wang, Hongxing; Liu, Nai-Kui; Zhang, Yi Ping; Deng, Lingxiao; Lu, Qing-Bo; Shields, Christopher B; Walker, Melissa J; Li, Jianan; Xu, Xiao-Ming

    2015-09-01

    Spinal cord injury (SCI) is devastating, causing sensorimotor impairments and paralysis. Persisting functional limitations on physical activity negatively affect overall health in individuals with SCI. Physical training may improve motor function by affecting cellular and molecular responses of motor pathways in the central nervous system (CNS) after SCI. Although motoneurons form the final common path for motor output from the CNS, little is known concerning the effect of exercise training on spared motoneurons below the level of injury. Here we examined the effect of treadmill training on morphological, trophic, and synaptic changes in the lumbar motoneuron pool and on behavior recovery after a moderate contusive SCI inflicted at the 9th thoracic vertebral level (T9) using an Infinite Horizon (IH, 200 kDyne) impactor. We found that treadmill training significantly improved locomotor function, assessed by Basso-Beattie-Bresnahan (BBB) locomotor rating scale, and reduced foot drops, assessed by grid walking performance, as compared with non-training. Additionally, treadmill training significantly increased the total neurite length per lumbar motoneuron innervating the soleus and tibialis anterior muscles of the hindlimbs as compared to non-training. Moreover, treadmill training significantly increased the expression of a neurotrophin brain-derived neurotrophic factor (BDNF) in the lumbar motoneurons as compared to non-training. Finally, treadmill training significantly increased synaptic density, identified by synaptophysin immunoreactivity, in the lumbar motoneuron pool as compared to non-training. However, the density of serotonergic terminals in the same regions did not show a significant difference between treadmill training and non-training. Thus, our study provides a biological basis for exercise training as an effective medical practice to improve recovery after SCI. Such an effect may be mediated by synaptic plasticity, and neurotrophic modification in the

  1. Lumbar dural sac dimensions determined by ultrasound helps predict sensory block extent during combined spinal-epidural analgesia for labor.

    PubMed

    Fanning, Niall; Arzola, Cristian; Balki, Mrinalini; Carvalho, Jose C A

    2012-01-01

    The lumbosacral cerebrospinal fluid volume is a major determinant of the intrathecal spread of local anesthetics. Ultrasound imaging of the lumbar spine allows measurement of dural sac dimensions, which may potentially be used as a surrogate of cerebrospinal fluid volume. The purpose of this study was to investigate the correlation between lumbar dural sac diameter, dural sac length (DSL), and dural sac volume (DSV), measured by ultrasound, and the intrathecal spread of isobaric bupivacaine during combined spinal-epidural (CSE) analgesia for labor. We examined 41 women with singleton pregnancies requesting neuraxial analgesia for labor. Using a 5-2-MHz curved-array ultrasound probe in the paramedian sagittal plane, we measured the dural sac width at each lumbar interspace and the DSL from L1-2 to L5-S1 interspace and calculated the dural sac volume (DSV). Following CSE block with 0.25% isobaric bupivacaine 1.75 mg and fentanyl 15 μg, peak sensory levels (PSLs) were recorded using ice, cotton, and pinprick. Statistical correlation coefficients between dural sac dimensions and PSLs were assessed by Spearman rank correlation. In addition, multiple linear regression models were used to select important predictors of PSLs. There was a moderate correlation between DSL and PSL to ice (ρ = -0.62; P < 0.0005) and to pinprick (ρ = -0.52; P = 0.017). Similarly, there was a moderate correlation between DSV and PSL to ice (ρ = -0.56; P = 0.004) and to pinprick (ρ = -0.61; P < 0.0008). Neither the DSL nor DSV correlated with PSL to cotton. Multiple linear regression analysis revealed that DSL, weight, and body mass index contributed to PSLs. The length of the lumbar spine determined by ultrasound, rather than the lumbar spine volume, combined with the weight or body mass index of the subject, is of particular value in predicting the intrathecal spread of isobaric bupivacaine during CSE analgesia for labor.

  2. Effect of lumbar spinal manipulation on local and remote pressure pain threshold and pinprick sensitivity in asymptomatic individuals: a randomised trial.

    PubMed

    Dorron, Sasha L; Losco, Barrett E; Drummond, Peter D; Walker, Bruce F

    2016-01-01

    The mechanisms of clinical pain relief associated with spinal manipulative therapy (SMT) are poorly understood. Our objective was to determine whether lumbar high-velocity low-amplitude SMT altered pressure pain threshold (PPT) and pinprick sensitivity (PPS) locally and remotely, how long any change lasted (up to 30 min), and whether changes related to the side of SMT. Thirty-four asymptomatic participants (mean age 22.6 years ±4.0) received a right- or left-sided lumbar SMT. PPT and PPS were measured bilaterally at the calf, lumbar spine, scapula, and forehead before and immediately, 10, 20, and 30 min after intervention. Data were collected between October 2014 and June 2015. Bilateral calf and lumbar spine PPT increased significantly after 10 - 20 min and was maintained at 30 min (7.2-11.8 % increase). PPS decreased significantly in all locations at various times (9.8 - 22.5 % decrease). At the calf and lumbar spine, PPT increased slightly more ipsilateral to the SMT than contralateral. Lumbar SMT reduced deep pressure sensitivity locally and in the lower limbs for at least 30 min, whereas sensitivity to pinprick was reduced systemically. These findings suggest that SMT specifically inhibits deep pressure sensitivity distally. These findings are novel compared to other lumbar SMT studies, and may reflect a local spinal or complex supraspinal analgesic mechanism. Registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000682640).

  3. Commentary: the sedimentation sign: correlation with operative level in patients undergoing lumbar decompression for spinal stenosis.

    PubMed

    Khanna, A Jay

    2013-08-01

    Fazal A, Yoo A, Bendo JA. Does the presence of the nerve root sedimentation sign on MRI correlate with the operative level in patients undergoing posterior lumbar decompression for lumbar stenosis? Spine J 2013;13:837-42 (in this issue). Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Tubular surgery with the assistance of endoscopic surgery via midline approach for lumbar spinal canal stenosis: a technical note.

    PubMed

    Mikami, Yasuo; Nagae, Masateru; Ikeda, Takumi; Tonomura, Hitoshi; Fujiwara, Hiroyoshi; Kubo, Toshikazu

    2013-09-01

    We devised a tubular surgery with the assistance of endoscopic surgery via midline approach to the spinal canal to preserve the bilateral facet joints and the paravertebral muscles when treating lumbar spinal canal stenosis. We report details of this operative procedure. A 2-cm incision is made in the skin in the midline of the intervertebral level to be decompressed. The spinous process on the cranial side is partially excised, and incisions along the ligament fiber are made in the midline of the supraspinous and interspinous ligaments to expose the ligamentum flavum. After the lamina and the inferior parts of the bilateral facet joints are adequately excised, the microendoscopic discectomy system is inserted. With this procedure, no muscular tissue is seen in the surgical site. The portal approach is small, but if full advantage is taken of the spinal microendoscope's merits, the bilateral facet joints are preserved and wide decompression of deep parts is possible. The microendoscope is positioned above the spinal canal to provide a good symmetrical field of view to enable easy anatomical orientation. Bilateral intervertebral joints were satisfactorily preserved in ten patients who received this surgery. All became ambulatory on the day after surgery and the clinical results remained favorable 3 years after the operation. Tubular surgery with the assistance of endoscopic surgery via a midline approach is a minimally invasive surgical procedure with favorable results that enables preservation of paravertebral muscles and bilateral facet joints.

  5. Metamorphosis-induced changes in the coupling of spinal thoraco-lumbar motor outputs during swimming in Xenopus laevis.

    PubMed

    Beyeler, Anna; Métais, Charles; Combes, Denis; Simmers, John; Le Ray, Didier

    2008-09-01

    Anuran metamorphosis includes a complete remodeling of the animal's biomechanical apparatus, requiring a corresponding functional reorganization of underlying central neural circuitry. This involves changes that must occur in the coordination between the motor outputs of different spinal segments to harmonize locomotor and postural functions as the limbs grow and the tail regresses. In premetamorphic Xenopus laevis tadpoles, axial motor output drives rostrocaudally propagating segmental myotomal contractions that generate propulsive body undulations. During metamorphosis, the anterior axial musculature of the tadpole progressively evolves into dorsal muscles in the postmetamorphic froglet in which some of these back muscles lose their implicit locomotor function to serve exclusively in postural control in the adult. To understand how locomotor and postural systems interact during locomotion in juvenile Xenopus, we have investigated the coordination between postural back and hindlimb muscle activity during free forward swimming. Axial/dorsal muscles, which contract in bilateral alternation during undulatory swimming in premetamorphic tadpoles, change their left-right coordination to become activated in phase with bilaterally synchronous hindlimb extensions in locomoting juveniles. Based on in vitro electrophysiological experiments as well as specific spinal lesions in vivo, a spinal cord region was delimited in which propriospinal interactions are directly responsible for the coordination between leg and back muscle contractions. Our findings therefore indicate that dynamic postural adjustments during adult Xenopus locomotion are mediated by local intraspinal pathways through which the lumbar generator for hindlimb propulsive kicking provides caudorostral commands to thoracic spinal circuitry controlling the dorsal trunk musculature.

  6. Appearance and vanishing of a spinal intradural arachnoid cyst after multiple epidural corticosteroid injections. A spontaneously resolving cause of symptomatic lumbar stenosis.

    PubMed

    Mailleux, P; Milbouw, G; Koerts, G; Verbeek, P; Willems, X

    2014-01-01

    Spinal intradural arachnoid cyst is a rare lesion, sometimes acquired. To describe the appearance and later spontaneous disappearence of a lumbar intradural arachnoid cyst, following perineural corticoid injections. Review of the clinical data and imaging, with final spontaneous return to initial state. Atypical intradural arachnoid cysts can be related to perineural injections and can cause symptoms of spinal stenosis. Its spontaneous vanishing is a very rare event, up to now unreported.

  7. Efficacy of acupuncture for degenerative lumbar spinal stenosis: protocol for a randomised sham acupuncture-controlled trial

    PubMed Central

    Qin, Zongshi; Ding, Yulong; Wu, Jiani; Zhou, Jing; Yang, Likun; Liu, Xiaoxu; Liu, Zhishun

    2016-01-01

    Introduction Degenerative lumbar spinal stenosis (DLSS) is a major public health problem and the primary reason why older adults seek lumbar spine surgery. Acupuncture may be effective for DLSS, but the evidence supporting this possibility is still limited. Methods and analysis A total of 80 participants with DLSS will be randomly allocated to either an acupuncture group or a sham acupuncture (SA) group at a ratio of 1:1. 24 treatments will be provided over 8 weeks. The primary outcome is the score change of the Modified Roland-Morris Disability Questionnaire (RMDQ) responses from baseline to week 8. The secondary outcomes include the assessment of lower back pain and leg pain using the Numeric Rating Scale (NRS), the change in the number of steps per month, and the assessment of the specific quality of life using the Swiss Spinal Stenosis Questionnaire (SSSQ). We will follow-up with the participants until week 32. All of the participants who received allocation will be included in the statistical analysis. Ethics/dissemination This protocol has been approved by the Research Ethical Committee of Guang'anmen Hospital (Permission number: 2015EC114) and Fengtai Hospital of Integrated Traditional and Western Medicine (Permission number: 16KE0409). The full data set will be made available when this trial is completed and published. Applications for the release of data should be made to ZL (principal investigator). Trial registration number NCT02644746. PMID:27852717

  8. Outcomes of Surgery in Patients with Lumbar Spinal Canal Stenosis: Comparison of Three Types of Stenosis on MRI

    PubMed Central

    Azimi, Parisa; Azhari, Shirzad; Benzel, Edward C.; Khayat Kashany, Hamid; Nayeb Aghaei, Hossein; Mohammadi, Hassan Reza; Ebrahimi, Meysam

    2016-01-01

    The aim of the study was to compare outcome of surgery in patients with lumbar canal stenosis (LCS) based on magnetic resonance imaging (MRI) morphology. This was a prospective study of 96 consecutive patients who underwent surgery at 143 levels of LCS (from L3-L4 to L5-S1). Using patterns on T2 axial MRI, the type of stenosis was determined for each patient. The Swiss Spinal Stenosis Score (SSS) was used to evaluate patients’ functionality and outcomes. The definition of treatment success was based on the criteria developed by Stucki et al. Demographic characteristics and post-operative outcomes were compared between trefoil, triangular, and pin-hole groups. Finally, correlation between SSS score and the MRI morphology was assessed. The mean age of patients was 58.4 (SD = 8.9) years. Post-treatment satisfaction was observed in a large portion of the patients (87.5%). The trefoil group (n = 44), triangular group (n = 38), and pin-hole group (n = 14) had similar pre-operative Swiss Spinal Stenosis Score and were not significantly different in age, operative time, blood loss, duration of symptoms, walking distance, symptom severity and physical function (all p>0.4). No correlation between SSS score and the MRI morphology was observed. The findings suggest that the type of stenosis based on magnetic resonance imaging morphology is not indicative of surgical outcome among lumbar canal stenosis patients who undergo surgery at 1-year follow-up. PMID:27333058

  9. [Influence of pedicle screws with different insertion depth on neighboring uninfused segments in a goat lumbar spinal fusion model].

    PubMed

    Gu, Jun; Wang, Yi-Jin; Duanmu, Qun-Li; Wu, Jun-Song; Han, Gui-He; Wu, Yong-Fang; Wei, Wei

    2010-11-01

    To observe the influences of pedicle screws in various insertion depth on the adjacent segment disc degeneration following lumbar spinal fusion. To explore the relationship between the internal fixation rigidity and incidence of adjacent segment disease. Sixteen hybrid male Bohr goats of 10 months old, weighting between 25 and 30 kg, were randomly devided into a control group (N group), and 3 experimental groups, each group had 4 goats. The L4 vertebra of each goat in the experimental groups was fractured, L3-L5 segments were internal fixed with pedicle screws followed by intervertebral joint fusion by a posterior approach. Three experimental groups were devided according to the length of pedicle screws applied, vertebras of goats in L group were internal fixed by the screws at the length of 25 mm, for M group and S group, 20 mm and 15 mm, accordingly. The goats in the control group were treated without any operation. Biomechanical changes and MRI index of upper unfused segment (L2) were measured 24 weeks after operation, and histological changes were observed as well. The pressure and straining of L2 vertebral body and intervertebral disc of L group increased more than N group (P < 0.05), and degenerated cell counting in nucleus pulposus increased as well (P < 0.05). However, MRI index remain unchanged (P > 0.05). Rigid internal fixation increases the pressure and straining of vertebral body and intervertebral disc of upper adjacent segment, accelerating the degeneration process following lumbar spinal fusion in goats.

  10. Lumbar interlaminar epidural injections in central spinal stenosis: preliminary results of a randomized, double-blind, active control trial.

    PubMed

    Manchikanti, Laxmaiah; Cash, Kimberly A; McManus, Carla D; Damron, Kim S; Pampati, Vidyasagar; Falco, Frank J E

    2012-01-01

    Chronic, persistent low back and lower extremity pain is often caused by spinal stenosis. Surgery and other interventions, including epidural injections, have been used to relieve this pain. However, there is little in the medical literature to support interlaminar, or transforaminal epidural injections under fluoroscopy for managing lumbar pain of central spinal stenosis, while the caudal epidural approach has been studied. A randomized, double-blind, active, control trial. A private, interventional pain management practice, specialty referral center in the United States. This study sought to determine if low back and lower extremity pain secondary to lumbar central stenosis can be managed and long-lasting pain relief can be achieved with interlaminar epidural injections of local anesthetic, with or without steroids. The study comprised 2 groups: one that received local anesthetic only and another received local anesthetic combined with nonparticulate betamethasone. A total of 120 patients were randomized by a computer-generated random allocations sequence to one of the 2 groups. The results of 30 patients in each group were assessed. Sixty patients were included in this analysis. Outcomes measurements were taken at baseline and at 3, 6, and 12 months post-treatment. Measurements taken were Numeric Rating Scale (NRS), the Oswestry Disability Index 2.0 (ODI), employment status and opioid intake. A decrease in both the NRS and ODI of  >/= 50% was considered significant. Significant pain relief and improvement in ODI scores were seen in both groups at 12 months. Group I's significant pain relief was 70%; Group II's was 63%. The significant ODI improvement in Group I was 70%; in Group II it was 60%. Group I patients on average received 3.8 procedures a year; Group II patients received 4.0 procedures a year in successful group. Over 52 weeks in the successful group, total relief for Group I was 40.8 ± 11.7 weeks; for Group II it was 37.1 ± 12.6 weeks. Combined pain

  11. The Influence of Pre- and Postoperative Fear Avoidance Beliefs on Postoperative Pain and Disability in Patients With Lumbar Spinal Stenosis: Analysis of the Lumbar Spinal Outcome Study (LSOS) Data.

    PubMed

    Burgstaller, Jakob M; Wertli, Maria M; Steurer, Johann; Kessels, Alfons G H; Held, Ulrike; Gramke, Hans-Fritz

    2017-04-01

    Prospective multicenter cohort study. To evaluate the effect of pre- and postoperatively assessed fear avoidance beliefs (FAB) on pain and disability in patients with degenerative lumbar spinal stenosis (LSS) after decompression surgery. To the present, the influence of pre- and postoperative FAB on the prognosis after surgery for LLS is still unclear. Patients of the Swiss Lumbar Stenosis Outcome Study (LSOS) with confirmed LSS undergoing first-time decompression without fusion were enrolled in this study. The main outcome of this study was minimal clinically important difference (MCID) in spinal stenosis measure symptoms (pain) and function (disability) after 12 months. To analyze the influence of pre- and postoperatively assessed FAB on pain and disability we built simple and multiple logistic regression models. In this analysis of 234 patients undergoing decompression surgery for symptomatic degenerative LSS we found baseline FAB measured by the FAB physical activity subscale (FABQ-P) not to be associated with pain (OR 0.95; 95% CI: 0.55-1.67) and disability (OR 1.11; 95% CI: 0.64-1.92) at 12 months' follow-up. In the final multiple logistic regression models patients with high FABQ-P at 6 months (OR 0.46; 95% CI: 0.24-0.91) and high persistent FABQ-P at baseline and 6 months (OR 0.34, 95% CI: 0.16-0.73) were less likely to report a MCID for spinal stenosis measure symptoms at 12 months. Our analysis found a similar trend for disability; however, the results were not statistically significant. In elderly patients undergoing decompression surgery for symptomatic degenerative LSS preoperative fear avoidance beliefs were not a prognostic indicator for the outcome. Patients with FAB at 6 months and persistent FAB were less likely to experience clinically relevant improvement in pain at 12 months. Studies should address the importance of persistent postoperative FAB. 3.

  12. Assessment of effectiveness of percutaneous adhesiolysis in managing chronic low back pain secondary to lumbar central spinal canal stenosis.

    PubMed

    Manchikanti, Laxmaiah; Cash, Kimberly A; McManus, Carla D; Pampati, Vidyasagar

    2013-01-01

    Chronic persistent low back and lower extremity pain secondary to central spinal stenosis is common and disabling. Lumbar surgical interventions with decompression or fusion are most commonly performed to manage severe spinal stenosis. However, epidural injections are also frequently performed in managing central spinal stenosis. After failure of epidural steroid injections, the next sequential step is percutaneous adhesiolysis and hypertonic saline neurolysis with a targeted delivery. The literature on the effectiveness of percutaneous adhesiolysis in managing central spinal stenosis after failure of epidural injections has not been widely studied. A prospective evaluation. An interventional pain management practice, a specialty referral center, a private practice setting in the United States. To evaluate the effectiveness of percutaneous epidural adhesiolysis in patients with chronic low back and lower extremity pain with lumbar central spinal stenosis. Seventy patients were recruited. The initial phase of the study was randomized, double-blind with a comparison of percutaneous adhesiolysis with caudal epidural injections. The 25 patients from the adhesiolysis group continued with follow-up, along with 45 additional patients, leading to a total of 70 patients. All patients received percutaneous adhesiolysis and appropriate placement of the Racz catheter, followed by an injection of 5 mL of 2% preservative-free lidocaine with subsequent monitoring in the recovery room. In the recovery room, each patient also received 6 mL of 10% hypertonic sodium chloride solution, and 6 mg of non-particulate betamethasone, followed by an injection of 1 mL of sodium chloride solution and removal of the catheter. Multiple outcome measures were utilized including the Numeric Rating Scale (NRS), the Oswestry Disability Index 2.0 (ODI), employment status, and opioid intake with assessment at 3, 6, and 12, 18 and 24 months post treatment. The primary outcome measure was 50% or more

  13. Assessment of Effectiveness of Percutaneous Adhesiolysis in Managing Chronic Low Back Pain Secondary to Lumbar Central Spinal Canal Stenosis

    PubMed Central

    Manchikanti, Laxmaiah; Cash, Kimberly A.; McManus, Carla D.; Pampati, Vidyasagar

    2013-01-01

    Background: Chronic persistent low back and lower extremity pain secondary to central spinal stenosis is common and disabling. Lumbar surgical interventions with decompression or fusion are most commonly performed to manage severe spinal stenosis. However, epidural injections are also frequently performed in managing central spinal stenosis. After failure of epidural steroid injections, the next sequential step is percutaneous adhesiolysis and hypertonic saline neurolysis with a targeted delivery. The literature on the effectiveness of percutaneous adhesiolysis in managing central spinal stenosis after failure of epidural injections has not been widely studied. Study Design: A prospective evaluation. Setting: An interventional pain management practice, a specialty referral center, a private practice setting in the United States. Objective: To evaluate the effectiveness of percutaneous epidural adhesiolysis in patients with chronic low back and lower extremity pain with lumbar central spinal stenosis. Methods: Seventy patients were recruited. The initial phase of the study was randomized, double-blind with a comparison of percutaneous adhesiolysis with caudal epidural injections. The 25 patients from the adhesiolysis group continued with follow-up, along with 45 additional patients, leading to a total of 70 patients. All patients received percutaneous adhesiolysis and appropriate placement of the Racz catheter, followed by an injection of 5 mL of 2% preservative-free lidocaine with subsequent monitoring in the recovery room. In the recovery room, each patient also received 6 mL of 10% hypertonic sodium chloride solution, and 6 mg of non-particulate betamethasone, followed by an injection of 1 mL of sodium chloride solution and removal of the catheter. Outcomes Assessment: Multiple outcome measures were utilized including the Numeric Rating Scale (NRS), the Oswestry Disability Index 2.0 (ODI), employment status, and opioid intake with assessment at 3, 6, and 12, 18

  14. Nocturnal leg cramps: a common complaint in patients with lumbar spinal canal stenosis.

    PubMed

    Matsumoto, Morio; Watanabe, Kota; Tsuji, Takashi; Ishii, Ken; Takaishi, Hironari; Nakamura, Masaya; Toyama, Yoshiaki; Chiba, Kazuhiro; Michikawa, Takehiro; Nishiwaki, Yuji

    2009-03-01

    Questionnaire survey on leg cramps for patients with lumbar spinal canal stenosis (LCS). To evaluate the prevalence of leg cramps in patients with LCS treated surgically and the relationship between leg cramps and the surgical outcomes. Although it has been anecdotally reported that LCS patients have suffered from leg cramps, the true prevalence remains unknown. One hundred twenty LCS patients who underwent decompression surgery (men 85, women 35, mean age 73.5) and 370 elderly subjects from the general population (men 162, women 208, mean age 75.6) were enrolled in the study. The participants filled in a questionnaire regarding: (all participants) (1) experience of leg cramps, (2) frequency and time of the day of the cramp attacks; (for LCS patients only), (3) changes in cramps before and after surgery, (4) activities of daily living disturbance because of leg cramps, (5) satisfaction with surgery and walking ability, (6) the Roland-Morris Disability Questionnaire, and (7) the Oswestry Disability Index. Eighty-five (70.8%) patients with LCS and 137 (37.2%) of the control population experienced leg cramps (age and sex adjusted odds ratio; 4.6, P < 0.01). Leg cramps occurred once or twice a week in 34.9% of the LCS group and once in several months in 44.5% of the control group, and occurred nocturnally in 73.3% of the LCS patients and in 91.6% of the control group. In LCS patients, leg cramps improved after surgery in 18.2%, remained unchanged in 45.5%, and worsened in 26.1%, and activities of daily living were disturbed in 47.6%. There was no significant difference in satisfaction with surgery, the Oswestry Disability Index, the Roland-Morris Disability Questionnaire scores, or walking ability between the LCS patients with or without leg cramps. LCS patients had significantly more frequent attacks of nocturnal leg cramps than the control population, and leg cramps disturbed the quality of the patients' life, and they rarely improved after decompression surgery. Leg

  15. Does This Older Adult With Lower Extremity Pain Have the Clinical Syndrome of Lumbar Spinal Stenosis?

    PubMed Central

    Suri, Pradeep; Rainville, James; Kalichman, Leonid; Katz, Jeffrey N.

    2012-01-01

    Context The clinical syndrome of lumbar spinal stenosis (LSS) is a common diagnosis in older adults presenting with lower extremity pain. Objective To systematically review the accuracy of the clinical examination for the diagnosis of the clinical syndrome of LSS. Data Sources MEDLINE, EMBASE, and CINAHL searches of articles published from January 1966 to September 2010. Study Selection Studies were included if they contained adequate data on the accuracy of the history and physical examination for diagnosing the clinical syndrome of LSS, using a reference standard of expert opinion with radiographic or anatomic confirmation. Data Extraction Two authors independently reviewed each study to determine eligibility, extract data, and appraise levels of evidence. Data Synthesis Four studies evaluating 741 patients were identified. Among patients with lower extremity pain, the likelihood of the clinical syndrome of LSS was increased for individuals older than 70 years (likelihood ratio [LR], 2.0; 95% confidence interval [CI], 1.6–2.5), and was decreased for those younger than 60 years (LR, 0.40; 95% CI, 0.29–0.57). The most useful symptoms for increasing the likelihood of the clinical syndrome of LSS were having no pain when seated (LR, 7.4; 95% CI, 1.9–30), improvement of symptoms when bending forward (LR, 6.4; 95% CI, 4.1–9.9), the presence of bilateral buttock or leg pain (LR, 6.3; 95% CI, 3.1–13), and neurogenic claudication (LR, 3.7; 95% CI, 2.9–4.8). Absence of neurogenic claudication (LR, 0.23; 95% CI, 0.17–0.31) decreased the likelihood of the diagnosis. A wide-based gait (LR, 13; 95% CI, 1.9–95) and abnormal Romberg test result (LR, 4.2; 95% CI, 1.4–13) increased the likelihood of the clinical syndrome of LSS. A score of 7 or higher on a diagnostic support tool including history and examination findings increased the likelihood of the clinical syndrome of LSS (LR, 3.3; 95% CI, 2.7–4.0), while a score lower than 7 made the diagnosis much less

  16. Spinal Headaches

    MedlinePlus

    ... spinal cord and, in the lower spine, the lumbar and sacral nerve roots. During a spinal tap, a sample of ... injected into your spinal canal to numb the nerves in the lower half of your ... also known as post-lumbar puncture headaches — resolve on their own with no ...

  17. The Influences of Different Ratios of Biphasic Calcium Phosphate and Collagen Augmentation on Posterior Lumbar Spinal Fusion in Rat Model

    PubMed Central

    Kim, Kyung-Hyun; Park, Jeong-Yoon; Park, Hyo-Suk; Kim, Keun-Su; Chin, Dong-Kyu; Cho, Yong-Eun

    2017-01-01

    Purpose To determine the influence of different ratios of hydroxyapatite (HA)/beta tricalcium phosphate (β-TCP) and collagen augmentation for posterior lumbar fusion in a rat model. Materials and Methods We generated a posterior lumbar fusion model in 50 rats and divided it into five groups of equal number as follows; 1) autologous bone graft as group A, 2) 70% HA+30% β-TCP as group B, 3) 70% HA+30% β-TCP+collagen as group C, 4) 30% HA+70% β-TCP as group D, and 5) 30% HA+70% β-TCP+collagen as group E. Rats were euthanized at 12 weeks after surgery and fusion was assessed by manual palpation, quantitative analysis using microCT and histology. Results The score of manual palpation was significantly higher in group C than group E (3.1±1.1 vs. 1.8±0.8, p=0.033). However, in terms of microCT analysis, group D showed significantly higher scores than group B (5.5±0.8 vs. 3.1±1.1, p=0.021). According to quantitative volumetric analysis, 30% HA+70% β-TCP groups (group D and E) showed significantly reduced fusion mass at 12 weeks after surgery (123±14.2, 117±46.3 vs. 151±27.3, p=0.008, 0.003, respectively). Collagen augmentation groups revealed superior results in terms of both microCT score and histologic grade. Conclusion A 7:3 HA/β-TCP ratio with collagen augmentation rather than a 3:7 HA/β-TCP ratio could be a more favorable graft substitute for lumbar spinal fusion. There was positive role of collagen as an adjunct for spinal bone fusion process. PMID:28120573

  18. The Influences of Different Ratios of Biphasic Calcium Phosphate and Collagen Augmentation on Posterior Lumbar Spinal Fusion in Rat Model.

    PubMed

    Kim, Kyung Hyun; Park, Jeong Yoon; Park, Hyo Suk; Kim, Keun Su; Chin, Dong Kyu; Cho, Yong Eun; Kuh, Sung Uk

    2017-03-01

    To determine the influence of different ratios of hydroxyapatite (HA)/beta tricalcium phosphate (β-TCP) and collagen augmentation for posterior lumbar fusion in a rat model. We generated a posterior lumbar fusion model in 50 rats and divided it into five groups of equal number as follows; 1) autologous bone graft as group A, 2) 70% HA+30% β-TCP as group B, 3) 70% HA+30% β-TCP+collagen as group C, 4) 30% HA+70% β-TCP as group D, and 5) 30% HA+70% β-TCP+collagen as group E. Rats were euthanized at 12 weeks after surgery and fusion was assessed by manual palpation, quantitative analysis using microCT and histology. The score of manual palpation was significantly higher in group C than group E (3.1±1.1 vs. 1.8±0.8, p=0.033). However, in terms of microCT analysis, group D showed significantly higher scores than group B (5.5±0.8 vs. 3.1±1.1, p=0.021). According to quantitative volumetric analysis, 30% HA+70% β-TCP groups (group D and E) showed significantly reduced fusion mass at 12 weeks after surgery (123±14.2, 117±46.3 vs. 151±27.3, p=0.008, 0.003, respectively). Collagen augmentation groups revealed superior results in terms of both microCT score and histologic grade. A 7:3 HA/β-TCP ratio with collagen augmentation rather than a 3:7 HA/β-TCP ratio could be a more favorable graft substitute for lumbar spinal fusion. There was positive role of collagen as an adjunct for spinal bone fusion process.

  19. Impact of pedicle-lengthening osteotomy on spinal canal volume and neural foramen size in three types of lumbar spinal stenosis

    PubMed Central

    Li, P.; Qian, L.; Wu, W. D.; Wu, C. F.

    2016-01-01

    Objectives Pedicle-lengthening osteotomy is a novel surgery for lumbar spinal stenosis (LSS), which achieves substantial enlargement of the spinal canal by expansion of the bilateral pedicle osteotomy sites. Few studies have evaluated the impact of this new surgery on spinal canal volume (SCV) and neural foramen dimension (NFD) in three different types of LSS patients. Methods CT scans were performed on 36 LSS patients (12 central canal stenosis (CCS), 12 lateral recess stenosis (LRS), and 12 foraminal stenosis (FS)) at L4-L5, and on 12 normal (control) subjects. Mimics 14.01 workstation was used to reconstruct 3D models of the L4-L5 vertebrae and discs. SCV and NFD were measured after 1 mm, 2 mm, 3 mm, 4 mm, or 5 mm pedicle-lengthening osteotomies at L4 and/or L5. One-way analysis of variance was used to examine between-group differences. Results In the intact state, SVC and NFD were significantly larger in the control group compared with the LSS groups (P<0.05). After lengthening at L4, the percentage increase in SCV (per millimetre) was LRS>CCS>FS>Control. After lengthening at L5 and L4-L5, the percentage increase in SCV (per millimetre) was LRS>FS>CCS>Control. After lengthening at L4 and L4-L5, the percentage increase in NFD (per millimetre) was FS>CCS>LRS>Control. After lengthening at L5, the percentage increase in NFD (per millimetre) was CCS>LRS>control>FS. Conclusions LRS patients are the most suitable candidates for treatment with pedicle-lengthening osteotomy. Lengthening L4 pedicles produced larger percentage increases in NFD than lengthening L5 pedicles (p < 0.05). Lengthening L4 pedicles may be the most effective option for relieving foraminal compression in LSS patients. Cite this article: P. Li, L. Qian, W. D. Wu, C. F. Wu, J. Ouyang. Impact of pedicle-lengthening osteotomy on spinal canal volume and neural foramen size in three types of lumbar spinal stenosis. Bone Joint Res 2016;5:239–246. DOI: 10.1302/2046-3758.56.2000469. PMID:27340140

  20. Impact of pedicle-lengthening osteotomy on spinal canal volume and neural foramen size in three types of lumbar spinal stenosis.

    PubMed

    Li, P; Qian, L; Wu, W D; Wu, C F; Ouyang, J

    2016-06-01

    Pedicle-lengthening osteotomy is a novel surgery for lumbar spinal stenosis (LSS), which achieves substantial enlargement of the spinal canal by expansion of the bilateral pedicle osteotomy sites. Few studies have evaluated the impact of this new surgery on spinal canal volume (SCV) and neural foramen dimension (NFD) in three different types of LSS patients. CT scans were performed on 36 LSS patients (12 central canal stenosis (CCS), 12 lateral recess stenosis (LRS), and 12 foraminal stenosis (FS)) at L4-L5, and on 12 normal (control) subjects. Mimics 14.01 workstation was used to reconstruct 3D models of the L4-L5 vertebrae and discs. SCV and NFD were measured after 1 mm, 2 mm, 3 mm, 4 mm, or 5 mm pedicle-lengthening osteotomies at L4 and/or L5. One-way analysis of variance was used to examine between-group differences. In the intact state, SVC and NFD were significantly larger in the control group compared with the LSS groups (P<0.05). After lengthening at L4, the percentage increase in SCV (per millimetre) was LRS>CCS>FS>Control. After lengthening at L5 and L4-L5, the percentage increase in SCV (per millimetre) was LRS>FS>CCS>Control. After lengthening at L4 and L4-L5, the percentage increase in NFD (per millimetre) was FS>CCS>LRS>Control. After lengthening at L5, the percentage increase in NFD (per millimetre) was CCS>LRS>control>FS. LRS patients are the most suitable candidates for treatment with pedicle-lengthening osteotomy. Lengthening L4 pedicles produced larger percentage increases in NFD than lengthening L5 pedicles (p < 0.05). Lengthening L4 pedicles may be the most effective option for relieving foraminal compression in LSS patients.Cite this article: P. Li, L. Qian, W. D. Wu, C. F. Wu, J. Ouyang. Impact of pedicle-lengthening osteotomy on spinal canal volume and neural foramen size in three types of lumbar spinal stenosis. Bone Joint Res 2016;5:239-246. DOI: 10.1302/2046-3758.56.2000469. © 2016 Ouyang et al.

  1. Tubercular spinal epidural abscess involving the dorsal-lumbar-sacral region without osseous involvement.

    PubMed

    Arora, Sumit; Kumar, Ramesh

    2011-07-27

    Musculoskeletal tuberculosis is known for its ability to present in various forms and guises at different sites. Tubercular spinal epidural abscess (SEA) is an uncommon infectious entity. Its presence without associated osseous involvement may be considered an extremely rare scenario. We present a rare case of tubercular SEA in an immune-competent 35-year-old male patient. The patient presented with acute cauda equina syndrome and was shown to have multisegmental SEA extending from D5 to S2 vertebral level without any evidence of vertebral involvement on MRI. The patient made an uneventful recovery following surgical decompression and antitubercular chemotherapy. The diagnosis was confirmed by histopathological demonstration of Mycobacterium tuberculosis in drained pus. Such presentation of tubercular SEA has not been reported previously in the English language based medical literature to the best of our knowledge.

  2. Foraminal and paraspinal extraforaminal attachments of the sixth and seventh lumbar spinal nerves in large breed dogs.

    PubMed

    Breit, S; Giebels, F; Kneissl, S

    2013-09-01

    Fresh cadaveric lumbar spines of 20 adult large breed dogs were used to study the sixth and seventh lumbar spinal nerves along their course through their respective intervertebral foramen. The relationship between the periosteum lining the vertebral canal (endorhachis; peridural membrane) and the vessels inside the vertebral canal, and the relationship between the nerves and the wall of the intervertebral foramen and the extraspinal suspensory apparatus were investigated. Each intervertebral foramen contained a fibrous septum that divided it into two sub-compartments by connecting the fibrous capsule of the facet joints with the intervertebral disc and the adjoining vertebral body. The lumbar nerves and the main artery passed through the cranial sub-compartment and the main vein passed through the caudal sub-compartment. In all cases, there was a circumneural sleeve that connected the ventral branches of the lumbar nerves extraspinally with the fibrous capsule of the facet joints dorsally, the fibrous septum caudally, and the caudal vertebral notch and accessory process cranioventrally. The deep layer of the circumneural sleeve was formed by the periosteum lining the vertebral canal pouching laterally through the intervertebral foramen; the superficial (lateral) layer was formed by the deep sheet of the thoracolumbar fascia. The deep sheet of the thoracolumbar fascia continued cranially and caudally to the circumneural sleeve to attach it to the vertebral body and the intervertebral disc. Regional and individual differences were noted in the composition and length of the circumneural sleeve. The potential biomechanical and clinical roles of these variations are discussed. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. Partially overlapping limited anterior and posterior instrumentation for adult thoracolumbar and lumbar scoliosis: a description of novel spinal instrumentation, "the hybrid technique".

    PubMed

    Boachie-Adjei, Oheneba; Charles, Gina; Cunningham, Matthew E

    2007-02-01

    Progressive and/or painful adult spinal deformity in the thoracolumbar and lumbar spine is sometimes treated surgically by long posterior fusions from the thoracic spine down to the pelvis, especially where there is a major thoracic curve component. Recent advances in anterior spinal instrumentation and spinal surgery technique have demonstrated the improved corrective ability offered by anterior stabilization systems, and the added benefit of limiting the number of vertebral fusion levels required for control of the deformity. The "hybrid technique" is a novel use of anterior instrumentation that applies limited anterior instrumentation down to the low lumbar spine (rods and screws), and partially overlapping short-segment posterior instrumentation to the sacrum (pedicle screws and rods). These constructs avoid posterior thoracic instrumentation and fusions, and avoid extension of posterior instrumentation to the pelvis. In the first 10 patients treated using this technique, thoracolumbar and lumbar major curve correction has averaged 71 and 82% in the immediate postoperative period (n = 7), respectively, and 59 and 68% at 2-year follow-up, respectively. The technique is an appealing and attractive alternative for treatment of thoracolumbar and lumbar scoliosis in the adult population, and avoids the requirement for applying spinal fixation to the thoracic spine and the pelvis.

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

    PubMed

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

    2013-06-01

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

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

    PubMed

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

    2017-01-01

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

  6. The value of dynamic radiographic myelography in addition to magnetic resonance imaging in detection lumbar spinal canal stenosis: A prospective study.

    PubMed

    Merkle, Martin; Maier, Gottlieb; Danz, Sören; Kaminsky, Jan; Tatagiba, Marcos S; Hebela, Nader M; Roser, Florian

    2016-04-01

    MRI is regarded as the study of choice in the diagnosis of lumbar spinal stenosis. In some cases, the supine MRI leads to a misdiagnosis in the extent of lumbar spinal stenosis. Dynamic myelography can detect lumbar spinal stenosis in these cases of where the MRI may not be as sensitive. To compare the sensitivities of dynamic radiographic myelography and supine MRI in lumbar canal stenosis (LCS) patients and to determine whether dynamic radiographic myelography is a valuable diagnostic exam in the work-up of lumbar canal stenosis. Over two years, the imaging data of 100 consecutive patients who were suspected of having LCS were prospectively analyzed. All lumbar intervertebral segments were evaluated in each patient on sagittal MR T2-weighted images and lateral plane images by myelography using a semi-quantitative scoring system. The differences in scores for 5 motion segments under 3 conditions (supine MRI, upright sitting myelography and standing myelography with extension) were analyzed statistically. Of 100 patients with 500 analyzed intervertebral segments, 23 patients with inconclusive supine MRI results had LCS in standing myelography with extension. Compared with upright sitting myelography and supine MRI, standing myelography with extension yielded the highest score for every segment from L1/2 to L5/S1. Compared with the upright sitting myelography position, 61 more patients received a diagnosis of lumbar stenosis in the standing myelography with extension position, and 121 more stenotic segments were diagnosed. Compared with the supine MRI position, standing myelography with extension detected 64 more stenotic patients and 137 more stenotic segments. n Based on a large patient sample, dynamic myelography is a valuable diagnostic tool in detecting lumbar spinal stenosis. Patients with lumbar spinal stenosis may have inconclusive supine MRI in 23% of cases being misdiagnosed as normal. This missed rate of LCS patients with unclear supine MRI results can be

  7. Transpedicular endoscopic surgery for lumbar spinal synovial cyst—report of two cases

    PubMed Central

    Krzok, Guntram; Wagner, Ralf; Iprenburg, Menno

    2016-01-01

    Background Lumbar facet cysts are a benign, degenerative, and fairly uncommon cause for lumbar radiculopathy. The standard surgical treatment for lumbar facet cysts often requires a laminectomy and medial facetectomy which can further destabilize a pathological motion segment. The authors present here a novel technique for transpedicular endoscopic access to the pathology that obviates the need to violate the lamina or facet. Methods Two patient cases are described where the lumbar 4–5 facet cysts arise medial to the pedicle. Percutaneous access to the cysts was established by drilling through the adjacent pedicle creating a 7-mm corridor to establish access for the endoscopic tubular retractor and the working channel endoscope. Straight and bendable forceps were used to remove the cysts under direct visualization. Results Following surgery, the patients’ symptoms showed immediate regression with complete relief of one patient’s foot drop by 6 months. Conclusions Transpedicular endoscopic access is described as novel minimally invasive surgical option in the awake patient for lumbar facet cysts adjacent to the Lumbar 4 or 5 pedicle. PMID:28097248

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

    PubMed

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

    2016-04-01

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

  9. Nonsurgical Korean Integrative Treatments for Symptomatic Lumbar Spinal Stenosis: A Three-Armed Randomized Controlled Pilot Trial Protocol

    PubMed Central

    Kim, Kiok; Shin, Kyung-Min; Lee, Jun-Hwan; Seo, Bok-Nam; Jung, So-Young; Youn, Yousuk; Lee, Sang Ho; Kim, Jaehong; Qu, Wenchun

    2016-01-01

    This is a study protocol for a pilot three-armed randomized controlled trial on nonsurgical integrative Korean medicinal treatment for symptomatic lumbar spinal stenosis (LSS). Thirty-six participants who have been diagnosed with (LSS) and recommended for spinal surgery by neurosurgeons or orthopedics and have had spinal symptoms such as severe low back pain and neurological claudication regardless of at least three months of conservative treatments will be recruited. Participants will be randomly assigned to be one of the three intervention groups, including the Mokhuri treatment program group 1 or 2 or usual care group. All treatments will be administered in inpatient units over a period of 4 weeks. The primary outcomes are 0 to 100 Visual Analogue Scales for low back pain and leg pain and the secondary outcomes are Oswestry Disability Index; EQ-5D; Roland-Morris Disability Questionnaire; Oxford Claudication Score; physical function test, including treadmill test, walking duration, and distance assessment for free leg pain; radiologic testing; and adverse events which will be assessed during the 4-week treatment period as well as after 3 and 6 months of follow-up. Then, we will assess the feasibility of the clinical trial design as well as a nonsurgical integrative treatment program. This trial is registered with CRIS registration number: KCT0001218. PMID:26941823

  10. A novel synthetic material for spinal fusion: a prospective clinical trial of porous bioactive titanium metal for lumbar interbody fusion.

    PubMed

    Fujibayashi, Shunsuke; Takemoto, Mitsuru; Neo, Masashi; Matsushita, Tomiharu; Kokubo, Tadashi; Doi, Kenji; Ito, Tatsuya; Shimizu, Akira; Nakamura, Takashi

    2011-09-01

    The objective of this study was to establish the efficacy and safety of porous bioactive titanium metal for use in a spinal fusion device, based on a prospective human clinical trial. A high-strength spinal interbody fusion device was manufactured from porous titanium metal. A bioactive surface was produced by simple chemical and thermal treatment. Five patients with unstable lumbar spine disease were treated surgically using this device in a clinical trial approved by our Ethics Review Committee and the University Hospital Medical Information Network. Clinical and radiological results were reported at the minimum follow-up period of 1 year. The optimal mechanical strength and interconnected structure of the porous titanium metal were adjusted for the device. The whole surface of porous titanium metal was treated uniformly and its bioactive ability was confirmed before clinical use. Successful bony union was achieved in all cases within 6 months without the need for autologous iliac crest bone grafting. Two specific findings including an anchoring effect and gap filling were evident radiologically. All clinical parameters improved significantly after the operation and no adverse effects were encountered during the follow-up period. Although a larger and longer-term follow-up clinical study is mandatory to reach any firm conclusions, the study results show that this porous bioactive titanium metal is promising material for a spinal fusion device.

  11. Surgical results in hidden lumbar spinal stenosis detected by axial loaded computed tomography and magnetic resonance imaging: an outcome study.

    PubMed

    Willén, Jan; Wessberg, Per J; Danielsson, Barbro

    2008-02-15

    An outcome study of patients with neurogenic claudication and/or sciatica with hidden stenosis, detected only by axial loading of the lumbar spine (ACE) but not at the traditional unloaded examination (psoas relaxed position) during computed tomography (CT) myelography or magnetic resonance imaging (MRI), followed up after surgery. To estimate the clinical effect of decompression with or without fusion in patients with hidden stenosis in the lumbar spine. A number of patients with neurogenic claudicatio with or without sciatica do not have corresponding imaging abnormalities. Axial loaded CT and MRI have disclosed hidden stenosis in certain cases. The surgical effect in patients with hidden stenosis has never been described. Axial loading of the lumbar spine during CT and MRI was performed in 250 patients with neurogenic claudication and sciatica. All fulfilled the inclusion criteria for ACE, i.e., suspected but not verified spinal stenosis in 1 to 3 levels. In 125 patients (50%), a significant narrowing of the spinal canal occurred. Out of these 125 patients, 101 had a clear stenosis besides the stenosis only detected at ACE. In 24 patients, a hidden stenosis was detected in 1 to 3 levels only at the ACE. These patients were observed for 1 to 6 years after decompression with or without fusion regarding subjective improvement of leg and back pains, walking capacity, satisfaction, and health related quality of life. At follow-up, 76% of the patients had leg pain less than 25/100 on a VAS scale and 62% had back pain less than 25/100. Ninety-six percent were improved or much improved regarding leg and back pains The ability to walk increased significantly after surgery. Walking capacity to more than 500 m increased from 4% to 87%. Twenty-two patients were subjectively satisfied with the surgical results. The ODI score, the SF-36 and the EQ-5D score corresponded well to the above mentioned improvements at follow-up. According to this study, the results of surgery in

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

    NASA Astrophysics Data System (ADS)

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

    2011-09-01

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

  13. Patient-reported outcome of surgical treatment for lumbar spinal epidural lipomatosis.

    PubMed

    Ferlic, Peter W; Mannion, Anne F; Jeszenszky, Deszö; Porchet, François; Fekete, Tamás F; Kleinstück, Frank; Haschtmann, Daniel

    2016-11-01

    Spinal epidural lipomatosis (SEL) is a rare condition characterized by an excessive accumulation of fat tissue in the spinal canal that can have a compressive effect, leading to clinical symptoms. This condition has a distinct pathology from spinal stenosis associated with degeneration of the intervertebral discs, ligaments, and facet joints. Several different conservative and surgical treatment strategies have been proposed for SEL, but its treatment remains controversial. There is a lack of evidence documenting the success of surgical decompression in SEL, and no previous studies have reported the postoperative outcome from the patient's perspective. The aim of the present study was to evaluate patient-rated outcome after surgical decompression in SEL. A retrospective analysis of prospectively collected data was carried out. A total of 22 patients (19 males; age: 68.2±9.9 years) who had undergone spine surgery for SEL were identified from our local Spine Surgery Outcomes Database, which includes a total of 10,028 spine surgeries recorded between 2005 and 2012. Inclusion criteria were epidural lipomatosis confirmed by preoperative magnetic resonance imaging (MRI) scans and subsequent decompression surgery without spinal fusion. The Core Outcome Measures Index (COMI) was used to assess patient-rated outcome. The COMI includes the domains pain (separate 0-10 scales for back and leg pain), back-specific function, symptom-specific well-being, general quality of life (QOL), work disability, and social disability. The questionnaires were completed preoperatively and at 3, 12, and 24 months postoperatively. Surgical data were retrieved from the patient charts and from our local Spine Surgery Outcomes Database, which we operate in connection with the International Spine Tango Registry. Differences between pre- and postoperative scores were analyzed using paired t tests and repeated measures analysis of variance. At 3-months follow-up, the COMI score and scores for leg

  14. Does experimental low back pain change posteroanterior lumbar spinal stiffness and trunk muscle activity? A randomized crossover study.

    PubMed

    Wong, Arnold Y L; Parent, Eric C; Prasad, Narasimha; Huang, Christopher; Chan, K Ming; Kawchuk, Gregory N

    2016-05-01

    While some patients with low back pain demonstrate increased spinal stiffness that decreases as pain subsides, this observation is inconsistent. Currently, the relation between spinal stiffness and low back pain remains unclear. This study aimed to investigate the effects of experimental low back pain on temporal changes in posteroanterior spinal stiffness and concurrent trunk muscle activity. In separate sessions five days apart, nine asymptomatic participants received equal volume injections of hypertonic or isotonic saline in random order into the L3-L5 interspinous ligaments. Pain intensity, spinal stiffness (global and terminal stiffness) at the L3 level, and the surface electromyographic activity of six trunk muscles were measured before, immediately after, and 25-minute after injections. These outcome measures under different saline conditions were compared by generalized estimating equations. Compared to isotonic saline injections, hypertonic saline injections evoked significantly higher pain intensity (mean difference: 5.7/10), higher global (mean difference: 0.73N/mm) and terminal stiffness (mean difference: 0.58N/mm), and increased activity of four trunk muscles during indentation (P<0.05). Both spinal stiffness and trunk muscle activity returned to baseline levels as pain subsided. While previous clinical research reported inconsistent findings regarding the association between spinal stiffness and low back pain, our study revealed that experimental pain caused temporary increases in spinal stiffness and concurrent trunk muscle co-contraction during indentation, which helps explain the temporal relation between spinal stiffness and low back pain observed in some clinical studies. Our results substantiate the role of spinal stiffness assessments in monitoring back pain progression. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Safety of Lumbar Spine Radiofrequency Procedures in Patients Who Have Posterior Spinal Hardware.

    PubMed

    Lamer, Tim J; Smith, Jolene; Hoelzer, Bryan C; Mauck, William D; Qu, Wenchun; Gazelka, Halena M

    2016-09-01

    The purpose of this study was to determine whether the energy generated by an active radiofrequency (RF) cannula adjacent to lumbar spine hardware could result in heating of the hardware. Prospective study. Tertiary care medical center. Six patients with lumbar facet joint pain at the level adjacent to lumbar spine fusion hardware were studied. A total of 10 lumbar medial branch nerve radiofrequency lesion procedures were performed on six patients. A temperature probe was placed on the fusion hardware to continuously monitor the temperature of the hardware throughout the RF procedure. The temperature of the fusion hardware increased in six of the 10 RF lesion procedures. During two of the procedures, the temperature rose rapidly to 42°C, at which time the procedure was ceased at that level. This study demonstrated that radiofrequency lesioning to treat symptomatic facet joint pain in patients who have adjacent posterior lumbar fusion hardware may result in heat energy being transferred to the adjacent hardware. This may increase the risk of injury to the patient. Monitoring for a temperature increase is easily accomplished by inserting a temperature probe onto the surface of the hardware. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  16. The patient's experience with non-surgical treatment for lumbar spinal stenosis: a qualitative study.

    PubMed

    Bove, Allyn M; Lynch, Andrew D; Ammendolia, Carlo; Schneider, Michael

    2017-09-01

    Lumbar spinal stenosis (LSS) is a highly prevalent disease in older adults that causes significant limitations in walking and other daily activities. There is a lack of research into optimal nonsurgical treatment approaches for LSS. The purpose of this qualitative study is to assess the opinions of participants in a randomized clinical trial of non-surgical LSS treatments regarding the interventions they received, factors contributing to adherence to the interventions, and methods of outcomes assessment. Qualitative focus group study; academic research center PATIENT SAMPLE: Individuals participating in a randomized clinical trial (RCT) for non-surgical LSS treatment were invited to discuss their study treatments and general experiences with LSS. The three treatment arms in the study were medical care, community-based group exercise, and clinic-based manual therapy and individual exercise. Following coding of qualitative data, kappa statistic was used to calculate agreement between observers. Themes were identified and agreed upon by both coders. This study was funded by the Patient-Centered Outcomes Research Institute (PCORI). Fifty individuals (28 female, mean age 73 ± 7.7 years) participated in a focus group. Two focus groups based on modified grounded theory were held for participants of each of the three treatment arms, for a total of six focus groups. Discussion topics included perceived effectiveness of the assigned treatment, suggestions for improvement, barriers and facilitators to completing treatment, and opinions of research outcome measures. Several themes were evident across all treatment groups. First, patients prefer individualized treatment that is tailored to their specific impairments and functional limitations. They also want to learn self-management strategies to rely less upon formal health care providers. Participants consistently stated that exercise improved their pain levels and physical function. However, they noted that these effects

  17. A 3D map of the hindlimb motor representation in the lumbar spinal cord in Sprague Dawley rats

    NASA Astrophysics Data System (ADS)

    Borrell, Jordan A.; Frost, Shawn B.; Peterson, Jeremy; Nudo, Randolph J.

    2017-02-01

    Objective. Spinal cord injury (SCI) is a devastating neurological trauma with a prevalence of about 282 000 people living with an SCI in the United States in 2016. Advances in neuromodulatory devices hold promise for restoring function by incorporating the delivery of electrical current directly into the spinal cord grey matter via intraspinal microstimulation (ISMS). In such designs, detailed topographic maps of spinal cord outputs are needed to determine ISMS locations for eliciting hindlimb movements. The primary goal of the present study was to derive a topographic map of functional motor outputs in the lumbar spinal cord to hindlimb skeletal muscles as defined by ISMS in a rat model. Approach. Experiments were carried out in nine healthy, adult, male, Sprague Dawley rats. After a laminectomy of the T13-L1 vertebrae and removal of the dura mater, a four-shank, 16-channel microelectrode array was inserted along a 3D (200 µm) stimulation grid. Trains of three biphasic current pulses were used to determine evoked movements and electromyographic (EMG) activity. Via fine wire EMG electrodes, stimulus-triggered averaging (StTA) was used on rectified EMG data to determine response latency. Main results. Hindlimb movements were elicited at a median current intensity of 6 µA, and thresholds were significantly lower in ventrolateral sites. Movements typically consisted of whole leg, hip, knee, ankle, toe, and trunk movements. Hip movements dominated rostral to the T13 vertebral segment, knee movements were evoked at the T13-L1 vertebral junction, while ankle and digit movements were found near the rostral L1 vertebra. Whole leg movements spanned the entire rostrocaudal region explored, while trunk movements dominated medially. StTAs of EMG activity demonstrated a latency of ~4 ms. Significance. The derived motor map provides insight into the parameters needed for future neuromodulatory devices.

  18. Firearm bullet settling into the lumbar spinal canal without causing neurological deficit: A report of two cases

    PubMed Central

    Hakan, Tayfun; Çerçi, Ajlan; Gürcan, Serkan; Akçay, Serkan

    2016-01-01

    Background: Uncertainty still exists regarding the treatment of the patients presenting with gunshot wounds to the spine. Neurological insults, cerebrospinal fluid fistula, infection, lead or copper toxicity, migration of bullets, and spinal instability are included among the common challenging issues. Case Description: An 18-year-old woman was admitted with low back pain following a gunshot injury five days ago. She was neurologically intact. Radiological examinations showed that a bullet was settled in L4-5 disc space. The bullet was removed with a unilateral L4-5 partial hemilaminectomy and discectomy from the left side. The second case was of a 29-year-old man admitted with radiating leg pain on the right side following a gunshot injury from his left side of lower back four months ago. He had only positive straight leg raising test. Radiological studies showed two bullets, one was in the psoas muscle on the left side and the other was in spinal canal that had caused a burst fracture of the L5 vertebra. Following L5 laminectomy and bilateral L5-S1 facetectomy, the bullet was removed from the spinal canal and L5-S1 transpedicular posterior stabilization was performed. The postoperative period of both patients was unremarkable. Conclusion: Bullet settling into the lumbar spinal canal without causing neurological deficit may require surgical intervention. Removal of bullets provided not only pain relief in both the cases but also prevented future complications such as migration of the bullets, plumbism, and neuropathic pain and instability. PMID:27213110

  19. The global alignment in patients with lumbar spinal stenosis: our experience using the EOS full-body images.

    PubMed

    Lazennec, Jean Yves; Folinais, Dominique; Bendaya, Samy; Rousseau, Marc Antoine; Pour, Aidin Eslam

    2016-10-01

    Lumbar stenosis is frequently observed and treated by spine surgeons. The extent of neurological decompression and the potential spinal fixation are the basic concerns when surgery is planned. But this segmented approach to the problem is sometimes insufficient due to the complex functional situations induced by a sagittal imbalance of the patient and the combination of pathologies known as hip-spine or knee-spine syndromes. A total of 373 consecutive patients included from our EOS and clinical data base. Patients were divided in two groups. Group A included patients presenting exclusive spinal issues (172 cases) out of whom 117 (68 %) had sagittal imbalance. Among 201 patients with associated lower limbs issues (group B), 122 (61 %) had sagittal imbalance. The perception of imbalance was noticed in 54 % (93 cases) in group A and 57 % (115 cases) in group B. In the global series of 239 imbalanced cases, the key point was a spine issue for 165 patients (the 117 patients with only spine problems and 48/122 cases with combined spine and lower limbs problems). But in the patients with combined spine and lower limbs problems, we individualized hip-spine syndromes (24/122 patients) and knee-spine syndromes (13/122 patients). In some cases, (37/122 patients) the anatomical and functional situations were more complex to characterize a spine-hip or a hip-spine problem. The EOS full-body images provide new information regarding the global spinal and lower limbs alignment to improve the understanding of the patient functional posture. This study highlights the importance of the lower limb evaluation not only as compensatory mechanism of the spinal problems but also as an individualized parameter with its own influence on the global balance analysis. Level of evidence IV diagnostic case series.

  20. Clinical and neuropsychiatric correlates of lumbar spinal surgery in older adults: results of a pilot study.

    PubMed

    Karp, Jordan F; McGovern, Jonathan; Marron, Megan M; Gerszten, Peter; Weiner, Debra K; Okonkwo, David; Kanter, Adam S

    2016-11-01

    To improve selection of older lumbar surgical candidates, we surveyed correlates of functioning and satisfaction with surgery. Prospective sample at lumbar spine surgery clinic. Patients (n = 48) were evaluated before surgery and after 3 months. Dependent variables were functioning and surgical satisfaction. Baseline variables associated with disability at 3 months included cognitive status and widespread pain. There was clinically significant improvement with moderate effects sizes for anxiety and depression at follow-up. Patients with at least a 30% improvement in disability had better physical health-related quality of life and were less likely to report widespread pain before surgery. Although preliminary, two novel potential predictors of lumbar surgery outcome include diminished cognitive functioning and widespread pain. Further study of these variables on post-surgical functioning and satisfaction may improve patient selection.

  1. Freeze-dried fibular allograft in anterior spinal surgery: cervical and lumbar applications.

    PubMed Central

    Wetzel, F. T.; Hoffman, M. A.; Arcieri, R. R.

    1993-01-01

    Fifty-six patients who underwent anterior fusion utilizing fibular allograft are reviewed. Thirty-two patients underwent multiple-level anterior cervical discectomy and fusion utilizing fibular strut allograft, and 24 underwent anterior lumbar discectomy and fusion using fibular strut allograft. Cervical surgery was performed via the strut technique of Whitecloud and LaRocca and lumbar surgery was performed via a transperitoneal or retroperitoneal approach. Postoperatively, patients were assigned a clinical grade based on symptomatic relief and medication usage. X-rays were visually inspected, and quantitatively digitized for Cobb angle and translation in order to assess the status of arthrodesis. In the cervical group, the rate of clinical success (87.5%) exceeded the arthrodesis rate. By inspection, 65% fused, at a mean time of 23.5 months postoperatively. In the lumbar group, the overall clinical success rate was 68%. This correlated quite strongly with a fusion rate of 58%. Smoking was a negative correlate with arthrodesis. Patients receiving Workers' Compensation were also more likely to have an unsatisfactory clinical outcome. The results of this study highlight the difference between anterior arthrodesis in the cervical and lumbar spine. The biomechanical stability afforded by the fibular strut in the cervical spine appears to outweigh the disadvantages of delayed time to union. The rate of posterior cervical fusion to salvage symptomatic pseudoarthrosis was quite low (9.3%), thus suggesting that additional posterior surgery in this particular group of patients should not be considered for a minimum of two years postoperatively. In the lumbar group, status of arthrodesis correlated closely with clinical outcome. Fusion rate in this group was disappointing, corresponding to other reports in the literature. Based on these data, primary anterior body fusion without allograft in the lumbar spine cannot be recommended, as a viable alternative to conventional

  2. Loss of lumbar lordosis. A complication of spinal fusion for scoliosis.

    PubMed

    La Grone, M O

    1988-04-01

    Symptomatic loss of lumbar lordosis is a disabling complication of scoliosis surgery. This so-called "flat-back syndrome" is characterized by an inability to stand erect and by upper back pain. Distraction instrumentation extending into the lower lumbar spine or sacrum is the most frequently identified etiologic factor responsible for loss of lordosis. The more distal the level of instrumentation, the severer the loss of lumbar lordosis. Other factors that may aggravate the loss of lordosis include thoracolumbar kyphosis, fixed thoracic kyphosis, hip flexion contractures, and pseudoarthrosis. Because of the wide range of values for kyphosis and lordosis in normal individuals, there is no absolute value that can be considered "normal." It is the overall sagittal plane balance that is most important. The most useful radiographic measurement to evaluate this sagittal plane balance is the full-length standing lateral radiograph with the knees extended. On this view, the C7-S1 measurement should fall within 2 cm of the anterior aspect of the sacrum. Surgical treatment for symptomatic loss of lumbar lordosis consists of closing wedge osteotomies through the fusion mass. This should generally be preceded by an anterior release and interbody fusion. Correction should be obtained at the site of the deformity with particular attention paid to the thoracolumbar junction. The surgery is difficult and the risk of complication is high. The most important aspect of this postural disorder is prevention. Avoid distraction instrumentation that extends into the lumbar spine if possible. When distraction instrumentation is used, the techniques described will help preserve lumbar lordosis. When performing a fusion to the sacrum, distraction instrumentation should not be used.

  3. Prone Position-Related Meralgia Paresthetica after Lumbar Spinal Surgery : A Case Report and Review of the Literature

    PubMed Central

    Lee, Ho Jun

    2008-01-01

    Lateral femoral cutaneous neuropathy occurring during spinal surgery is frequently related to iliac bone graft harvesting, but meralgia paresthetica (MP) can result from the patient being in the prone position. Prone position-related MP is not an uncommon complication after posterior spine surgery but there are only few reports in the literature on this subject. It is usually overlooked because of its mild symptoms and self-limiting course, or patients and physicians may misunderstand the persistence of lower extremity symptoms in the early postoperative period to be a reflection of poor surgical outcome. The authors report a case of prone position-related MP after posterior lumbar interbody fusion at the L3-4 and reviewed the literature with discussion on the incidence, pathogenesis, and possible risk factors related to this entity. PMID:19137086

  4. Does Co-Existing Lumbar Spinal Canal Stenosis Impair Functional Outcomes and Activity Levels after Primary Total Hip Arthroplasty?

    PubMed

    Jauregui, Julio J; Banerjee, Samik; Issa, Kimona; Cherian, Jeffrey J; Mont, Michael A

    2015-09-01

    Degenerative lumbar spinal stenosis (LSS) is a cause for substantial morbidity in the elderly population: many often undergo total hip arthroplasty for associated hip arthritis. With a matched cohort we investigated the effect of co-existing LSS on aseptic survivorship, functional outcomes, activity levels, overall subjective physical and mental health status, and satisfaction rates in patients undergoing primary THA. The aseptic-implant survivorship was similar in LSS and non-stenosis cohort. Although both cohorts significantly improved, the LSS cohort achieved lower improvements in HHS, UCLA, SF-36 physical, and satisfaction rates than the matched non-stenotic cohort. Surgeons should consider cautioning patients with LSS that although they can expect relief of their arthritic symptoms following THA, they may continue to expect limitations in function, physical-status, activity-levels, and satisfaction rates. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Prone position-related meralgia paresthetica after lumbar spinal surgery : a case report and review of the literature.

    PubMed

    Cho, Keun-Tae; Lee, Ho Jun

    2008-12-01

    Lateral femoral cutaneous neuropathy occurring during spinal surgery is frequently related to iliac bone graft harvesting, but meralgia paresthetica (MP) can result from the patient being in the prone position. Prone position-related MP is not an uncommon complication after posterior spine surgery but there are only few reports in the literature on this subject. It is usually overlooked because of its mild symptoms and self-limiting course, or patients and physicians may misunderstand the persistence of lower extremity symptoms in the early postoperative period to be a reflection of poor surgical outcome. The authors report a case of prone position-related MP after posterior lumbar interbody fusion at the L3-4 and reviewed the literature with discussion on the incidence, pathogenesis, and possible risk factors related to this entity.

  6. [Lumbar nerve root pain with fever in tropical area: posterior spinal tuberculosis].

    PubMed

    Ouédraogo, D D; Daboiko, J C; Eti, E; Ouali, B; Ouattara, B; Gbané, M; Gbazi, C; Kouakou, N M

    2008-12-01

    The purpose of this report is to describe the case of tuberculosis osteitis of the posterior vertebral arch in a 35-year-old man with recent history of pulmonary tuberculosis. Clinical findings were pain due to bilateral inflammation of the lumbar nerve roots, fistulised cold abcess and motor deficit in both lower extremities. The tomodensitometry demonstrated a lytic bone lesion involving the spinous process of the second lumbar vertebra in association with spondylitis and a large paravertebral abscess with calcification typical of tuberculosis. Cure was achieved by a single 12-month course of appropriate treatment.

  7. Health behavior change counseling in surgery for degenerative lumbar spinal stenosis. Part I: improvement in rehabilitation engagement and functional outcomes.

    PubMed

    Skolasky, Richard L; Maggard, Anica M; Li, David; Riley, Lee H; Wegener, Stephen T

    2015-07-01

    To examine whether a brief motivational interviewing [MI]-based health behavior change counseling (HBCC) intervention increased patient participation in physical therapy and/or home exercise programs (HEPs), reduced disability, and improved health status after surgery for degenerative lumbar spinal stenosis. Prospective clinical trial. Academic medical center. From December 2009 through August 2012, consecutive patients (N=122) underwent surgery for degenerative lumbar spinal stenosis and, based on enrollment date, were prospectively assigned to a control (n=59) or HBCC intervention (n=63) group in a prospective, lagged-control clinical trial. Brief MI-based HBCC versus attention control. Rehabilitation participation (primary); disability and health status (secondary). Therapists assessed engagement in, and patients reported attendance at, postoperative rehabilitation (physical therapy and/or HEP). At 3 and 6 months, disability and health status were assessed (Oswestry Disability Index [ODI] and Medical Outcomes Study 12-Item Short-Form Health Survey, version 2 [SF-12v2]) (significance, P<.05). Compared with controls, HBCC patients had significantly higher rehabilitation engagement (21.20±4.56 vs 23.57±2.71, respectively; P<.001), higher physical therapy (.67±.21 vs .82±.16, respectively; P<.001) and HEP (.65±.23 vs .75±.22, respectively; P=.019) attendance, and better functional outcomes at 3 months (difference: ODI, -10.7±4.4, P=.015; SF-12v2, 6.2±2.2, P=.004) and 6 months (difference: ODI, -12.7±4.8, P=.008; SF-12v2, 8.9±2.4, P<.001). The proportion of the HBCC intervention impact on functional recovery mediated by rehabilitation participation was approximately half at 3 months and one-third at 6 months. HBCC can improve outcomes after spine surgery through improved rehabilitation participation. Copyright © 2015 American Congress of Rehabilitation Medicine. All rights reserved.

  8. A Comparison of Radiostereometric Analysis and Computed Tomography for the Assessment of Lumbar Spinal