Showing papers on "Lumbar vertebrae published in 1976"

Mechanical properties of dried defatted spongy bone.

Abstract: A study has been made of the compressive strength, compression at rupture, limit of proportionality, compression at the limit of proportionality and the modulus of elasticity of spongy bone from vertebrae and tibias. The specimens were obtained from autopsy subjects of both sexes aged 14 to 89 years. There was a qualitative deterioration of most of the strength parameters with age, and also differences between the sexes and between vertebrae and tibia. Spongy bone was found to have the unusual mechanical property that, despite rupture, its compressive strength often steadily increased; this was especially the case for vertebrae from young males.

Post-laminectomy and post-fusion stenosis of the lumbar spine.

Abstract: On the basis of a 9-year experience with 231 patients with post-laminectomy and post-spinal fusion stenosis of the lumbar spinal canal, we emphasize the importance of recognizing and adequately decompressing such lesions. In the majority of such patients pain relief has been achieved, but some of the failures can be attributed to technical reasons. Most failures are due to associated lesions and to functional factors. A special surgical techniy be advisable. The indications for fusion however were few and require further investigation and evaluation. The significant failure rate points to the need for continuing research into the causes of low back pain and adequate management programs for the patient with the "multiple operated back" who still has disabling pain and drug dependence.

Some aspects of aging in the lumbar spine

Abstract: I measured the bodies of vertebrae L3 and L4 of 338 skeletons from the Terry collection in the Smithsonian Institution, including Blacks and Whites, males and females, aged from 20 to 90 years. Transverse breadths of the upper and lower endplates (excluding osteophytes) and minimum transverse breadths all increase with age. In general, the greater broadening occurs in the endplates, but the middle of the body also broadens to such a degree that there is no demonstrable increase in vertebral "flaring" with age. In males, posterior body height decreases relative to anterior height, so that the lumbar bodies become more wedge-shaped with age but females show essentially no change. Anterior height decreases in proportion to minimum breadth, so that the lumbar bodies become relatively lower and broader, and this change is significantly correlated with age in all groups. Midbody height decreases relative to anterior height, so that Nordin's biconcavity index is reduced with age. The increase in biconcavity remains evident even when average anterior-posterior height is used to calculate the index. At all age levels a high percentage of individuals have biconcavity indices of 80% or less, indicating that Nordin's standard of normality for this index, established from measurement on radiographs of the living, should be revised downward for use in evaluating osteoporosis in skeletal populations.

Measurements of the lumbar spinal canal in 2 racial groups.

Abstract: Direct measurements of 1,340 lumbar vertebrae in 275 skeletons in two racial groups are reported. The average figure, and the upper and lower limits of normal are reported for the anteroposterior diameter of the canal and for Spinal Index. Radiological studies have established a technique for defining the posterior margin of the spinal canal on plain X-ray films. It is formed by a line joining the apex of the superior to the inverted apex of the inferior articular facet. The Spinal Index is not a reliable factor. The anteroposterior diameter alone is the essential parameter in assessing spinal stenosis. The negroid canal is marginally less spatial than that of the caucasoid.

Late results of removal of the loose posterior element (Gill's operation) in the treatment of lytic lumbar spondylolisthesis.

Abstract: This study presents the late results of the Gill operation for the treatment of lytic lumbar spondylolisthesis in 75 patients. The observation time ranged for 5 to 20 years, averaging 12 years. Primary results were excellent, good or fair in 83 per cent at the end of 1 year. However, the figures dropped to 75 per cent when the cases were evaluated 5 or more years after operation. The worsening of the results during the observation time seems to depend on the degeneration of the intervertebral disk. Progression of olisthesis was observed in 27 per cent of the patients, usually in connection with progression of disk degeneration. This progression did not affect the clinical result of treatment. Nine patients had a lumbar disk herniation, 8 from a segment above the level of defect and 1 at that level. On 9 patients a fusion was later performed as a secondary operation. In these the late result was still unsatisfactory in all but 2. The operation is contraindicated in adolescents except in exceptional cases with signs of compression of the cauda equina. It is not recommended for patients below the age of 30 years. The main indication for the Gill operation is painful spondylolisthesis with nerve root symptoms in patients over 40 years of age.

Lumbar spondylosis and neuropathic bladder: investigation of 73 patients with chronic urinary symptoms.

Abstract: Seventy-three patients presented with either chronic urinary symptoms such as incontinence, retention, and recurrent urinary infection or chronic low back pain and neurogenic claudication. Lumbar spondylosis was considered to be the major cause of the urological and skeletal symptoms; the diagnosis of a neuropathic bladder depended as much on features in the history as on the results of urological and neurological investigations. The preoperative demonstration of significant lumbar spondylosis was often difficult, but decompressive laminectomy in 34 patients produced relief of urinary symptoms and improvement in bladder function in 75%.

Roentgen findings in fractures of the vertebral column in childhood examination of 35 patients and its results.

Abstract: In the past 10 years we examined 35 children with fractures of the spine. The most important cause was an injury by a fall from a tree or a climbing stage (23 cases). Traffic accidents or other direct trauma was the cause in 10 patients. Two children had tetanus. The ages of the children range from 2 to 12 years. Clinical symptoms may be diagnostic of vertebral trauma, but quite often symptoms are insignificant or atypical. We detected fractures in every vertebra of the thoracic and lumbar part of the spine. The greatest number of fractures was found between T4 and L2. The typical injury of the spine is a compression fracture of the vertebral body with a wedgeshaped deformity (111 vertebrae); fractures of the transverse processus of lumbar vertebrae were not frequent (10 vertebrae). Other parts of the vertebrae were not involved. The value of scintigraphy in case of doubtful roent-genologic finding is pointed out.

Etiology of spondylolisthesis

Abstract: The etiology of spondylolisthesis is multiple according to the type of the vertebral slipping. In fact all the following basic pathological processes may be involved: congenital malformation of the upper sacrum in the dysplastic spondylolisthesis; growth dysplasia of the vertebral arch in the "isthmic spondylolisthesis" where an hereditary background and mechanical stresses play a determining role; degenerative conditions of the intervertebral joints in "degenerative spondylolisthesis" of Newman or the "pseudospondylolisthesis" of Junghanns; infections and benign or malignant tumors destroying the articular bolt maintaining the vertebral line; traumatic lesions such as multiple fractures of the bony hook or much more rarely an isolated bilateral fracture of the pars interarticularis.

Spinal changes in idiopathic chondrocalcinosis articularis

Abstract: The lumbar-spine radiographs of 67 patients with idiopathic chondrocalcinosis articularis were reviewed for disc calcification and other changes. Calcification was present in 21 (31%) of the patients, seen most frequently at the L 2-3 disc space. The 21 patients as a group were significantly older than the 46 patients without disc calcification, and also had a much higher incidence of chondrocalcinosis in peripheral joints. There was no association with back pain or spinal stiffness. The 21 patients with disc calcification included six patients with a destructive peripheral arthropathy, and three of them had destructive changes affecting the lumbar spine. Three patients with a destructive peripheral arthropathy were also included in the group without disc calcification, and one of these had a destructive arthritis of the lumbar spine. For comparison, there was a 55% incidence of spinal chondrocalcinosis in nine patients with primary hyperparathyroidism and peripheral joint chondrocalcinosis, and a 6% incidence in 100 anteroposterior lumbar spine radiograph 'controls', taken before intravenous urography, although in this latter group the changes were minimal and confined to the margin of a single disc in each case.

Transfemoral lumbar epidural venography

Abstract: Lumbar epidural venography performed in 107 patients with normal or nondiagnostic myelograms resulted in correct preoperative diagnosis in 25 of 27 patients (92%) with herniated disc disease and three of six patients (50%) with nerve root compression without associated disc herniation. Compression or occlusion of an epidural and/or radicular vein at the disc level is the most significant venographic abnormality. Potentially confusing venographic findings such as flow defects, extravertebral veins mimicking epidural veins, and occlusion of radicular veins by the catheter must be recognized to prevent false diagnoses. Lumbar epidural venography is valuable for the diagnoses of herniated lumbar discs not demonstrated by myelography.

Fatty Marrow in the Vertebrae a Parameter for Hematopoietic Activity in the Aged

Abstract: Fatty alteration of bone marrow was analyzed in upper lumbar vertebrae obtained from 94 autopsies. Of these, 85 were from individuals over 60 years of age. Fatty marrows were classified grossly into three groups: Group I, a massive type, Group II, a moderate or less significant type; Group III, a nonfatty type. Fatty marrows of Groups I and II were found most frequently in the older subjects. They were not observed (0/9) below 60 years of age, but were present in 42% (5/12) in the 6th decade, 61% (23/38) in the 7th decade, 76% (25/33) in the 8th decade, and 100% (2/2) in the 9th decade. This may relate to a decreasing volume of a reservoir stem cell compartment for blood cell generation. Since the vertebral marrow is the last reserve site for hematopoietic activity, the volume of fatty marrow in the vertebrae may be used as a parameter for the estimation of hematopoietic activity in the entire skeletal system in the aged.

Normal “Cupid's Bow” Contour of the Lower Lumbar Vertebrae

Abstract: The inferior end plates of the 3d, 4th, and 5th lumbar vertebral bodies frequently have paired parasagittal concavities when viewed in the frontal projection. When viewed in the lateral projection, the concavities superimpose, lying in the posterior portion of the vertebral body. This normal contour of the end plate should not be confused with other vertebral body anomalies having clinical importance. The incidence and degree of end plate depression are discussed.

Lumbar spinal stenosis. Radiographic diagnosis with special reference to transverse axial tomography.

Abstract: Spinal stenosis due to malalignment and/or hypertrophy of the bony margins of the spinal canal is a recognized cause of cauda equina compression and nerve root entrapment. The plain lumbosacral spine roentgenograms reveal the number of lumbar vertebrae, their alignment, their interpedicular distances, the height of the intervertebral disk spaces and the presence of osteophyte formation. It correlates poorly with encroachment on the spinal canal. The transverse axial tomogram directly demonstrates a cross-section of the spinal canal and will show abnormal areas of bone encroachment usually arising from hypertrophied lamina and articular processes. These narrow the posterior portion of the spinal canal and encroach on the lateral recesses. This examination does not demonstrate soft tissue hypertrophy and the stenosis may be even greater than what is apparent due to the bony encroachment. The myelogram expresses how the narrowed spinal canal affects the dural sac and its contained cauda equina. Not infrequently there is an associated herniated disk.

Comparison of disk excision and combined disk excision and spinal fusion for lumbar disk ruptures.

Abstract: In a series of private patients 77 per cent over-all satisfactory results were obtained from surgical disk excision performed without spinal fusion. Patients in whom spinal fusion combined with discectomy has been recommended by other authors are not much more satisfied than patients with discectomy alone without fusion (81% versus 74% satisfactory). Patients in whom the third party influence prevails were significantly more dissatisfied (only 59% satisfactory). Findings of a definite disk rupture at the time of surgery result in a higher incidence of satisfactory rating than those with degenerative changes or with normal findings.

Forces on lumbo-vertebral facets.

Abstract: The forces acting on the human lumbar vertebrae in a variety of postures are analyzed using the principles of engineering statistics. It is concluded that the pressures exerted on the interarticular joints can be at least as large as the pressures on the intervertebral discs when lifting heavy weights in flexion. Since 1934, the ruptured disc has been the focus of interest. The stresses and pressures incurred by the intervertebral discs remain undisputed and have been well documented by several authors. More recently, an autoimmune reaction has been demonstrated to occur in cases with degenerative disc protrusion. The possibility that such a reaction may actually occur prior to rupture of the disc has also been entertained. The purpose of this paper is not to detract from the importance and significance of the intervertebral disc, but to include the equally important synovial joints in our comprehension of the biomechanics and the pathophysiology of the lumbar spine. It is postulated that the facets may be injured simultaneously whenever there is a disc injury or may be injured exclusively without a disc injury. Injury to the facets is bound to produce a painful state of affairs which may lead to degenerative arthritis and contribute to the chronic low-back-pain syndrome.

Recognition of vertebral abnormalities in computed tomography of the chest and abdomen.

Abstract: Computed tomography of the chest or abdomen may reveal vertebral abnormalities. Images in multiple projections of dry and fresh specimens of the spine demonstrate that osteophytes, end-plate irregularities, and marked obliquity fail to mimic true osteoblastic vertebral lesions. Disk calcification may simulate a metastatic deposit if the section includes both disk and vertebral body. Abdominal or chest “window” settings produce an apparent increase in bone density. Analysis of the bony spine from abdominal and chest images requires gray scale settings different from those used for the study of visceral organs.

Surface strain distribution in isolated single lumbar vertebrae.

Abstract: The surface strains of isolated single lumbar vertebrae under compressive load were examined by the techniques of brittlecoat and photoelastic analysis. Directions of principal strain components have been determined. Areas of stress concentration were found around the vertebral rims, near the pedicles, and around the foramina of the basivertebral veins.

Facetectomy for the relief of intraforaminal compression of the fifth lumbar root at the collapsed lumbosacral disk.

Abstract: This paper presents a long-term follow-up of 23 patients with collapsed lumbosacral disks showing evidence of fifth lumbar root compression treated by facetectomy without fusion. Fifth lumbar root compression is usually caused by protrusion of the fourth lumbar disk. If this is not present the fifth lumbar root will almost invariably be found to be impinged upon laterally in the foramen by one of several mechanisms, which are detailed in this paper. Decompression of the roots at the fifth lumbar foramen may be done by either unilateral or bilateral facetectomy depending upon whether the symptoms are unilateral or bilateral. There has been no forward displacement with unilateral facetectomy and only slight forward movement of the fifth lumbar vertebrae on the sacrum with bilateral facetectomy. There has been good relief of symptoms in most patients. Arthrodesis, as a rule, is not necessary.

[Morphology and mechanics of rotation of the small joint in the lumbar vertebra (author's transl)].

Abstract: Using macerated and nonmacerated lumbar vertebrae and/or whole lumbar vertebral columns as well as x-rays, the attempt was made to contribute to the knowledge of the mechanics of the small joint in the lumbar section of the spinal column on the basis of the shape of the joint surfaces. The joint surfaces of the lumbar vertebral column deviate from the usual demonstration of primarily angular surfaces. Right and left joint surfaces of a locomotor segment do not lie on the same geometrical plane, i.e., there is nothing like a common right and left curvature center. As a result, conclusions can be drawn in regard to the role played by the small joint of the lumbar vertebral column under the various types of strain during movement, particularly during rotation. The relation of the small joint in rotation positions was demonstrated radiographically in isolated preparations of individual locomotor segments.

Parting of lumbar vertebrae - with apparatus for use by slipped disc patients in the home

Abstract: Apparatus for extending part of the vertebral column, e.g. the lumbar vertebrae, comprises belts which are applied to various parts of the body of a patient lying stretched out on a substrate, and a winch or other tensioning means which applied an extending force to the vertebral column. A frame which extends mainly in one plane includes on its narrow sides supports for attaching the belts: the winch engages the belts in one direction of stretching, and the belts are attached directly to their supports in the other direction of stretching. The frame is pref. divided in the middle of the two longitudinal sides.

Arterial vascularization of the lumbar vertebrae

Abstract: The authors have studied the vascularization in the lumbar verebrae. All arteries originate in the arteriae lumbales. They form an internal supply plexus and a peripheral periosteal plexus. The internal supply plexus is formed by radicular arteries divided into an anterior branch (the abdominal artery), with its corporeal branches, and a posterior branch (the dorsal artery) forming the arcus posterior. The periosteal plexus is formed by an anterior plexus for the corpus vertebrae and a posterior plexus for the arcus posterior. Intra-osseous vascularization at the level of the corpus vertebrae has been described; showing a difference between foetuses and adults. In the foetus, the posterior supply vessels predominate, whereas in the adult, the anterior periosteal vessels predominate. At the arcus posterior there is no difference between foetuses and adults.