Showing papers on "Lumbar vertebrae published in 1977"

Degenerative changes in the intervertebral discs of the lumbar spine and their sequelae

Abstract: Careful pathological examination of lumbar spines removed at autopsy has shown that degenerative changes are present in the intervertebral discs of all subjects by middle age. The degenerative changes are more marked and occur at an earlier age when evidence of vertical or posterior disc prolapse is also present. Degenerative changes in the discs are always accompanied by osteophyte formation on the margins of the vertebral bodies and remodelling changes in the apophyseal joints. There is a direct relationship between the degree of disc degeneration, marginal osteophyte formation on vertebral bodies, and apophyseal joint changes, which suggests that disc degeneration is the primary event leading to the clinical condition of 'degenerative spondylosis'.

Harrington instrumentation and spine fusion for unstable fractures and fracture-dislocations of the thoracic and lumbar spine.

Abstract: Of forty patients with unstable fractures and fracture-dislocations of the thoracic or lumbar spine treated with Harrington instrumentation and spine fusion, thirty-five had a neural deficit (twenty-three with incomplete or cauda equina lesions and twelve with complete lesions). Laminectomy or posterolateral decompression was performed prior to instrumentation and fusion in twenty-three patients and at the time of stabilization, in thirteen. Solid fusion was obtained in all but one patient. Back pain persisted in four. No patient had residual spinal deformity. Twenty-one patients with incomplete or cauda equina lesions regained some neural function, while all twelve with complete lesions remained unchanged. The advantages of this technique include effective stabilization of the spine, early mobilization and rehabilitation, and prevention of late deformity.

The morphometry and pathological anatomy of the lumbar spine in South African negroes and caucasoids with specific reference to spinal stenosis

Abstract: Direct measurements were made on 2,166 lumbar vertebrae of 433 adult negro and caucasoid skeletons. On statistical analysis, forty-five vertebrae in twenty-seven skeletons were found to be stenotic, the mid-sagittal diameter being the significantly reduced dimension. Whereas spinal stenosis syndromes are rare in South African negroes, the lumbar canal is marginally narrower in the negro. There is a uniformity of configuration and capacity of the lumbar spinal canal, which transcends race and sex. By a new method of determining the dorsal limit of the lumbar canal on lateral plain radiography, the overall average lower limit of normal of the mid-sagittal diameter is established at 15 millimetres, and of the transverse diameter 20 millimetres. Bony degenerative changes are more likely to cause neurological compression in the nerve root tunnel than in the spinal canal. The role of skeletal narrowing of the spinal canal as an exclusive cause of the spinal stenosis syndrome may have been exaggerated.

Analysis of gas in vacuum lumbar disc

Abstract: In three cases in which chemonucleolysis with chymopapain was used for the treatment of back and sciatic pain, gas from the vacuum phenomenon of a degenerated lumbar intervertebral disc was recovered. In one of these, the gas analyzed by gas chromatography contained 90%--92% nitrogen.

The risk of neurologic damage with fractures of the vertebrae.

Abstract: The incidence of spinal cord injury with spine fractures and dislocations is approximately 14% of the total as ascertained from a survey of these injuries in Northern California, and 17% of traumatic spinal cord injuries gave no overt radiographic evidence of vertebral injury. Patients sustaining fractures of the vertebral bodies and posterior elements with some degree of malalignment of the spine had a 61% incidence of neurologic deficit. Injuries to the cervical spine most often produced neurologic damage, the incidence of neurologic deficit being 39%. Motor vehicle collisons continue to be the major cause of these injuries and the victim is usually a young adult male.

The vertebral level of origin of spinal nerves in the rat

Abstract: Several dissections were performed to determine the level of spinal cord termination and the vertebral level at which the dorsal and ventral roots of spinal nerves C1-S4 emerged from the spinal cord in the rat. These levels of emergence were then compared to the level of exit from the vertebral canal. The dissections demonstrated that the effect of differential growth between spinal cord and vertebral column begins in the lower cervical region and becomes progressively more pronounced throughout thoracic and lumbar levels. The disparity between the vertebral level of emergence of spinal roots from the spinal cord and their level of exit via intervertebral foramina was found to be considerably larger than was previously reported by Greene ('68). It was further noted that the spinal cord terminated at the level of the intervertebral disc between the third and fourth lumbar vertebrae, not between the fourth and fifth lumbar vertebrae as reported by Greene ('68).

Reactive sclerosis of a pedicle and spondylolysis in the lumbar spine

Abstract: Eleven patients were seen with reactive sclerosis and hypertrophy of one pedicle and lamina of a lumbar vertebra and a contralateral spondylolysis in the same vertebral segment. Differentiating the reactive sclerosis in this condition from that associated with osteoid-osteoma is necessary since excision of a sclerotic pedicle associated with contralateral spondylolysis will create painful instability. In asymptomatic patients observation is sufficient, while in those with symptoms not relieved by external immobilization, spine fusion, usually of three levels, is indicated.

Rheumatoid involvement of the lumbar spine.

Abstract: On stereoscopic examination of the lumbar spines of 6 patients with rheumatoid arthritis and spinal disease we found typical rheumatoid erosions in the apophyseal joints. 2 also had severe asymmetrical disc destruction with associated involvement of the vertebral bodies and scoliosis. In one of these patients who developed Staphyloccocus aureus septicaemia, infection was localized in this part of the lumbar spine.

Paravertebral and peripheral ligamentous ossification: an unusual association of hypoparathyroidism.

Abstract: A 62-year-old man with idiopathic hypoparathyroidism and extensive paravertebral and ligamentous ossification is reported. The clinical and radiological findings of this, and other reported cases, are discussed and compared with other causes of paravertebral ossification.

Fatigue characteristics of posterior elements of vertebrae

Abstract: The fatigue strength of vertebral posterior elements was determined by applying repetitive forces to the inferior joints between the articular processes of human rhesus-monkey vertebrae. The results indicate that in vivo stresses resulting from unusual activities for sustained periods can induce fatigue fracture of the lumbar vertebrae. Comparison of these data with those of other investigators suggests the use of ultimate strength as a normalizing factor to correlate fatigue-strength data obtained under different test conditions.

Verification of roentgenographic landmarks in the lumbar spine

Abstract: Using biplanar roentgenography, the three–dimensional spatial locations of various bony landmarks on the human lumbar vertebrae were calculated, and their positions compared with anatomically determined values via sectional technique. A previously described method was found to be accurate for localizing bony landmarks in space when the vertebral end–plates or superior pedicles could be seen on anteroposterior and lateral films. The experimental technique simulated in vivo conditions, suggesting that biplanar roentgenography is a useful method for study of vertebral orientation and motion in living subjects.

Antero-lateral decompression as a treatment of paraplegia following vertebral fracture in the thoraco-lumbar spine.

Abstract: Thirty-two patients with paraplegia following vertebral fracture were treated by anterolateral decompression operation. In all cases there was a compression of the spinal cord from the front. Seven patients, three with complete motor paralysis and incomplete sensory loss and four with incomplete motor paralysis and incomplete sensory loss, made a complete recovery. Ten patients made a good recovery, and seven were improved after the decompression procedure. In six cases no improvement was noted. One patient got neuralgia of the intercostal nerves after the operation and the complete paraplegia remained unchanged. Another patient with a complete paraplegia died of uremia one year after operation.

A new method for the accurate localization of 239Pu in bone.

Abstract: The method, which is based on semi-automatic digitization of neutron induced autoradiographs, allows the 239Pu to be localized with respect to bone surfaces with an accuracy of about +or-2 mu m. Results are presented for the distribution of 239Pu in the central lumbar vertebrae of female CBA mice at 24 h post-injection.

The lumbar sympathetic. Anatomy and surgical implications.

Abstract: The ganglionated lumbar sympathetic chains lie on the lateral aspects of the bodies of the lumbar vertebrae and not more laterally as in the thorax where the chain lies in relation to the heads and necks of the ribs. Lumbar ganglia vary in number. They are best numbered according to the spinal nerve to which the particular ganglion sends its postganglionic fibers, but, at operation, the surgeon is unable to obtain this kind of information. It is customary to mark the extent of resection by the application of a dura clip to the proximal and distal ends of the trunk. Roentgenographic visualization later can approximate the level of resection in relation to the vertebrae. Anomalies can lead to unsuccessful denervation of the lower extremities. These include extraganglionic connecting sympathetic nerve trunks, intermediate ganglia, and cross-over fibers connecting the right and left lumbar sympathetic trunks usually at the level of the fourth and fifth lumbar segments, but anatomically sometimes as high as the third and second. Specific complications of lumbar sympathectomy include failure of adequate denervation, brief paralytic ileus, hyperidrosis in parts of the body which remain normally innervated, sexual dysfunction, and post-sympathectomy neuralgia.

Bilateral fracture of the pedicles through the fourth and fifth lumbar vertebrae with anterior displacement of the vertebral bodies. Case report.

Abstract: Figs. I-A and I-B: Anteroposterior and lateral roentgenograms of the lumbar spine, demonstrating the anterior displacement of the bodies of the fourth and fifth lumbar vertebrae with fractures through the pedicles. Figs. 2-A and 2-B: Stabilization was performed with bilateral Harnington instrumentation rods from the first lumbar vertebra to the sacrum. Posterolateral fusion with iliac grafts was performed over the same vertebrae.

Visualization of the posterolateral elements of the lumbar vertebrae in the anteroposterior projection.

Abstract: A radiographic view in the AP projection for visualization of the laminae and articular processes of the lumbar vertebrae is described. This view may be used for the acutely injured patient. In addition to augmenting standard views, the AP projection will assist, and may supplant the need for tomography in selected cases.

[Value of Dimer-X myelography in the diagnosis of lumbar intravertebral disk lesions].

Abstract: On the basis of 500 myelogramms carried out with hexaiodated, water soluble, and rapidly absorbable Dimer X, the experiences gained in the diagnoses of damages of the lumbar intervertebral disks are presented. It can be stated that Dimer-X myelography has proved to be very useful for the recognition of space-narrowing processes in the lumbar region. No serious complications were observed. Most of the troubles, including, for example, transitory headache and the like, correspond to those sometimes found after simple lumbar punctures.

Use of the halo-pelvic apparatus for treatment of fracture-dislocations of the thoracic and lumbar spines accompanied by paraplegia.

Abstract: Twenty-five cases of paraplegia due to fracture-dislocations of the thoracic and lumbar vertebrae were treated using the halo-pelvic apparatus. Thirteen of them only needed the apparatus, two underwent laminectomy, and ten had posterior spinal fusion in addition. The advantages of this method are that gentle reduction can be achieved without severe complications, and that posterior spinal fusion can be performed with this apparatus on, thus enabling an early start to the subsequent exercise program and minimal absence from work.

Chronischer, epiduraler intraspinaler Abszeß nach Lumbalpunktion

Abstract: Symptoms clinical course, and also statistical data are recroded for a 60-year-old man with a chronic epidural abscess in the lumbar vertebrae 3/4 following a lumbar puncture. Acute and chronic epidural intraspinal abscesses are discussed in relation to the relevant literature.

[Spinal subdural abscess-report of a case (author's transl)].

Abstract: A successfully treated case with a spinal subdural abscess in the lumbar region is reported. The patient, a 58-year-old male, had been suffered from fever and pain in the back for 2 months prior to the visit to a hospital, where pus was obtained through a lumbar puncture. He was then admitted to the Neurosurgical Clinic, Gunma University Hospital on September 6, 1974. On admission, neurological examination revealed an alert patient with flaccid paraparesis, sensory disturbance in bilateral lower limbs and urinary retention. Stiffness of the neck and Lasegue's sign were observed. The body temperature was 38.7 degrees C, white blood cell count 18,900/mn3, and erythrocyte sedimentation rate 118 mn per hour. Pus was again obtained from the spinal canal through a lumbar puncture between the fourth and fifth lumbar vertebrae. Cerebrospinal fluid obtained by a cisternal puncture was colorless clear, and the cell count was 60 WBCs/mn3, protein 154 mg/dl, and glucose 90 mg/dl. Plain roentgenograms of the spine were normal. Myelography showed a block at the level of the first thoracic vertebra, being accompanied with irregular subarachnoid defects. A lumbar laminectomy was performed on September 12, and an abscess adhering to the cauda equina was totally extirpated from the subdural space. Smear of the pus contained Gram-positive bacilli, but the culture was negative. Postoperative course was uneventful, and the neurological deficits were gradually improved. Fifteen months later, the patient could walk with a stick. A review of the available literature, including the present report, lists 14 cases with spinal subdural abscesses which have been induced via hematogenous spread. The symptomotology, clinical diagnosis, treatment and prognosis are briefly discussed. It should be emphasized that early diagnosis and emergency treatment are of choice in order to obtain an excellent operative morbidity.

Intervertebral disc space infection: another low back syndrome of the young.

Abstract: Pyogenic disc space infection is a rare and unappreciated cause of low back pain. Reported herein is a young man with chronic low back pain and the HLA-B27 antigen which initially led to the diagnosis of ankylosing spondylitis. However, serial lumbar radiographs and bone scan established an inflammatory lesion involving the L2-L3 intervertebral disc space, and persistently normal sacroiliac joints. A needle biopsy and culture of the disc space yielded Staphylococuss aureus. Treatment with antibiotics, bed rest and back bracing resulted in a complete resolution of symptoms and healing of the vertebral lesion. It is the purpose of this report to review the clinical, laboratory and radiographic features of intervertebral disc space infection as well as pitfalls in its diagnosis.

Method of combined surgical treatment of compression forms of lumbar osteochondrosis with alloprosthesis of damaged intervertebral disks

Abstract: A method of surgical treatment of compressive forms of osteochondrosis of the lumbar portion of the vertebral column is described, the said method being based on the employment of a prosthetic replacement of the intervertebral disks with a promptly hardening polyurethane SKU-PFL. Along with the decompression of nervous and vascular structures in the vertebral canal the introduced technique permits to correct the stato-dynamic incompetance of the spine. 62 patients were followed-up for up to 5 years. Better results were noted in patients with a clinical pattern of radicular compression. A less distinct therapeutic effect was achieved in a group of patients with the caudal syndrome, and was due to persistent gross neurological deficits.

[Scoliosis and spondylolisthesis (author's transl)].

Abstract: The coincidence of a scoliosis with a lumbosacral spondylolysis or spondylolisthesis has remained largely ignored in the German language literature. After a survey of the foreign literature the pathogenesis of various combination forms is discussed. Primarily with the aid of oblique X-rays of lumbar scoliosis a scheme of classification involving 7 categories is worked out. The two main categories comprise unstable spondylolisthetic scolioses with increasing abnormal posture and scoliotic spondylolistheses. In these cases a lumbar scoliosis probably induces an asymmetric spondylolysis. The scheme provides the basis for discussion of conservative and surgical treatment. Taking of a standing X-ray is indispensable as a preliminary measure with every lumbar scoliosis. Oblique X-rays of the lumbosacral section appear to be equally necessary at least once. Unilateral laminar sclerosis can be a valuable sign of contralateral one-sided spondylolyses, as can scoliotic E-forms of the spinal column as well. Spondylolisthetic "scolioses" should be fused in the lumbosacral section at an early stage to prevent secondary structural curvatures. Scoliotic spondylolyses-spondylolistheses at this level should on the other hand, only be fused in serious cases accompanied by pain and progression, supplementing dorsolumbar fusion of scoliosis. In any case, the lowest lumbar vertebra must only be fused in an almost straight position. The correction should also be carried out in the case of difficult spondylolisthetic scolioses prior to the lumbosacral dorsolateral fusion using the v. Lackum transsection cast if certain, above all neurologic, findings permit.

Congenital absence of the lumbo-sacral spine. A report of an unusual case.

Abstract: A 47-year-old woman with complete absence of the lumbar and sacral spine had complete fecal and urinary continence, as well as successful social and functional adaptation without any surgical, prosthetic or rehabilitative assistance.

Vertebral osteomyelitis due to Pseudomonas aeruginosa.

Abstract: A case of vertebral osteomyelitis due to Pseudomonas aeruginosa is described and the problems of diagnosis and treatment discussed.