Showing papers on "Lumbar vertebrae published in 1996"
TL;DR: It appears that there is an ample stability safety margin during tasks that demand a high muscular effort, however, lighter tasks present a potential hazard of spine buckling, especially if some reduction in passive joint stiffness is present.
1,075 citations
TL;DR: Vertebroplasty of metastases is a minimally invasive procedure that provides immediate and long-term pain relief and contributes to spinal stabilization.
Abstract: PURPOSE: To determine the efficacy of percutaneous vertebroplasty in treating spinal metastases that result in pain or instability. MATERIALS AND METHODS: Thirty-seven patients (20 men, 17 women; aged 33-86 years) underwent 52 percutaneous injections of surgical cement into a vertebra (vertebroplasty) with fluoroscopic guidance in 40 procedures. Vertebroplasty was performed for analgesia in 29 procedures, stabilization of the vertebral column in five procedures, and both in six procedures. RESULTS: Twenty-four of the 33 procedures performed for analgesia that were evaluated resulted in clear improvement; seven, moderate improvement; and two, no improvement. Improvement was stable in 73% of patients at 6 months. In the procedure performed for stabilization, no displacement of treated vertebrae was observed (mean follow-up, 13 months). Three patients had transient radiculopathy due to cement extrusion, and two patients had transient difficulty in swallowing. CONCLUSION: Vertebroplasty of metastases is a min...
733 citations
TL;DR: Correct placement of transpedicular screws for spinal fusion seems to be more difficult than it looks and the computed tomography scanning is useful for differential diagnosis of postoperative radicular syndromes after lumbartranspedicular fixation.
Abstract: Study design: The location of pedicle screws (n = 42) in four human specimens of the lumbar spine and in 30 patients (n = 131 screws) after lumbar spinal fusion was assessed using computed tomography.
Objectives: To determine the accuracy of pedicle screw placement in lumbar vertebrae and the reproducibility and repeatability of the computed tomography examination.
Summary of background data: Failures in the placement of transpedicular screws for lumbar fusion are reported. The evaluation of such screws using computed tomography examination has not been investigated.
Methods: After surgery, the specimens were dissected in transversal slices to observe macroscopically the location of the pedicle screw and to correlate these observations with the computed tomography images. All patients were examined by one observer. To determine the reproducibility and repeatability of the computed tomography examination, two observers studied computed tomography images of 12 patients (n = 58 screws) twice within 3 months.
Results: In the specimens, 10 screws were observed to penetrate the medial wall of the pedicle. This correlated fully with the images. In the patients' group, 40% of all screws penetrated the cortex of the vertebra. Of all screws, 29% penetrated the medial wall of the pedicle. From the computed tomography images, it appeared that a deviation of more than 6 mm medially was a high risk for nerve root damage. Three months after his first examination, Observer 1 documented a different position in three of 58 screws (kappa = 0.90). Observer 2 found a different position in eight screws (kappa = 0.65). The comparison between the reviews of the two observers showed a different opinion for the first evaluation, four disagreements (2-4 mm) and 17 disagreements (0-2 mm; kappa = 0.34), and for the second evaluation, four disagreements (2-4 mm) and 12 disagreements (0-2 mm; kappa = 0.43).
Conclusions: Correct placement of transpedicular screws for spinal fusion seems to be more difficult than it looks. The computed tomography scanning is useful for differential diagnosis of postoperative radicular syndromes after lumbar transpedicular fixation.
429 citations
TL;DR: At a 1‐year evaluation of patient‐reported outcomes, patients with severe lumbar spinal stenosis who were treated surgically had greater improvement than patients treated nonsurgically.
Abstract: Study design A prospective cohort study of patients with lumbar spinal stenosis recruited from the practices of orthopedic surgeons and neurosurgeons throughout Maine. Objective To assess 1-year outcomes of patients with lumbar spinal stenosis treated surgically or nonsurgically. Summary of background data No randomized trials and few nonexperimental studies have compared surgical and nonsurgical treatment of patients with lumbar spinal stenosis. The authors' goal was to assess 1-year outcomes of patients with lumbar spinal stenosis treated surgically or nonsurgically. Methods Eligible, consenting patients participated in baseline interviews and were then mailed follow-up questionnaires at 3, 6, and 12 months. Clinical data were obtained from a physician questionnaire. Outcomes included patient-reported symptoms of leg and back pain, functional status, disability, and satisfaction with care. Results One hundred forty-eight patients with lumbar spinal stenosis were enrolled, of whom 81 were treated surgically and 67 treated nonsurgically. On average, patients in the surgical group had more severe imaging findings and symptoms and worse functional status than patients in the nonsurgical group at entry. Few patients with mild symptoms were treated surgically, and few patients with severe symptoms were treated nonsurgically. However, of the patients with moderate symptoms, a similar percent were treated surgically or nonsurgically. One year after study entry, 28% of nonsurgically and 55% of surgically treated patients reported definite improvement in their predominant symptoms (P = 0.003). For patients with moderate symptoms, outcomes for surgically treated patients were also improved compared with those of nonsurgically treated patients. Surgical treatment remained a significant determinant of 1-year outcome, even after adjustment for differences between treatment groups at entry (P = 0.05). The maximal benefit of surgery was observed by the time of the first follow-up evaluation, which was at 3 months. Although few nonsurgically treated patients experienced a worsening of their condition, there was little improvement in symptoms and functional status compared with study entry. Conclusions At a 1-year evaluation of patient-reported outcomes, patients with severe lumbar spinal stenosis who were treated surgically had greater improvement than patients treated nonsurgically. Comparisons of outcomes by treatment received must be made cautiously because of differences in baseline characteristics. A determination of whether the outcomes observed persist requires long-term follow-up.
338 citations
TL;DR: The increase in facet angles at levels other than that of the spondylolisthesis suggests that increased facet angles represent variations in anatomy rather than a secondary result of spondyolistshesis.
Abstract: The orientation of the lumbar facet joints was studied with magnetic resonance imaging in 140 subjects to determine if there is an association between facet tropism and intervertebral disc disease or between the orientation of the facet joints and degenerative spondylolisthesis. The 140 subjects were divided into four groups: sixty-seven asymptomatic volunteers, forty-six of whom did not have a herniated disc on magnetic resonance scans (Group I) and twenty-one who did (Group II); forty-six symptomatic patients who had a herniated disc confirmed operatively (Group III); and twenty-seven patients who had degenerative spondylolisthesis at the interspace between the fourth and fifth lumbar vertebrae (Group IV). Axial scans were made at each lumbar level and digitized, and the facet joint angle was measured by two independent observers with use of image analysis software in a personal computer. The technique of measurement of the facet angles on magnetic resonance scans was validated with a subset of subjects who also had computed tomography scans made. Similar values were obtained with the two methods (r = 0.92; p = 0.00001). For the forty-six asymptomatic volunteers who did not have a herniated disc on the magnetic resonance scans (Group I), the median facet tropism was 5 to 6 degrees and was more than 10 degrees in 24 per cent (eleven) of the subjects. There was no association between increased facet tropism and disc degeneration. At the level of the fourth and fifth lumbar vertebrae, the median facet tropism was 10.3 degrees in the symptomatic patients who had a herniated disc at the same level and 5.4 degrees in the asymptomatic volunteers (Group I) (p = 0.05). The mean orientation of the lumbar facet angles relative to the coronal plane was more sagittal at all levels in the patients who had degenerative spondylolisthesis. The greatest difference was at the level of the fourth and fifth lumbar vertebrae (p = 0.000001). The mean facet angle was 41 degrees (95 per cent confidence interval, 37.6 to 44.6 degrees) in the asymptomatic volunteers and 60 degrees (95 per cent confidence interval, 52.7 to 67.1 degrees) in the patients who had degenerative spondylolisthesis. Furthermore, both the left and the right facet joints were more sagittally oriented in the patients who had degenerative spondylolisthesis. An individual in who both facet-joint angles at the level of the fourth and fifth lumbar vertebrae were more than 45 degrees relative to the coronal plane was twenty-five times more likely to have degenerative spondylolisthesis (95 per cent confidence interval, seven to ninety-eight times). The increase in facet angles at levels other than that of the spondylolisthesis suggests that increased facet angles represent variations in anatomy rather than a secondary result of spondylolisthesis.
301 citations
TL;DR: There is a significant association between the presence of extensive peridural scar and the occurrence of recurrent radicular pain and the probability of recurrent pain increases when scar score increases.
Abstract: The purpose of this study was to investigate the presence of any correlation between recurrent radicular pain during the first six months following first surgery for herniated lumbar intervertebral disc and the amount of lumbar peridural fibrosis as defined by MR imaging. 197 patients who underwent first-time single-level unilateral discectomy for lumbar disc herniation were evaluated in a randomized, double-blind, controlled multicenter clinical trial. Clinical assessments, performed by physicians blinded to patient treatment status, were conducted preoperatively and at one and six months postoperatively. The enhanced MR images of the operative site utilized in the analysis were obtained at six months postoperatively. Radicular pain was recorded by the patient using a validated visual analog pain scale in which 0 = no pain and 10 = excruciating pain. The data obtained at the 6 month time point were analyzed for an association between amount of peridural scars as measured by MR imaging and clinical failure as defined by the recurrence of radicular pain. The results showed that the probability of recurrent pain increases when scar score increases. Patients having extensive peridural scar were 3.2 times more likely to experience recurrent radicular pain than those patients with less extensive peridural scarring. In conclusion, this prospective, controlled, randomized, blinded, multicenter study has demonstrated that there is a significant association between the presence of extensive peridural scar and the occurrence of recurrent radicular pain.
263 citations
TL;DR: Gadolinium-enhanced and unenhanced MR images are useful in the differentiation of vertebral collapses and are suggestive of osteoporosis and malignancy.
Abstract: PURPOSE: To distinguish malignant from osteoporotic acute vertebral collapses. MATERIALS AND METHODS: Sixty-three osteoporotic and 30 malignant vertebral collapses were studied in 51 patients (aged 33-88 years) with T1-weighted magnetic resonance (MR) images (n=93), gadolinium-enhanced T1-weighted images (n=72), and T2-weighted images (n=53). RESULTS: Four findings were suggestive of osteoporosis: retropulsion of a bone fragment (10 osteoporotic cases vs 0 malignant cases), preservation of normal signal intensity on T1-weighted images (43 vs four), return to normal signal intensity after gadolinium injection (42 vs four) with horizontal bandlike patterns, and isointense vertebrae on T2-weighted images (28 vs two). Six findings were suggestive of malignancy: convex posterior cortex (21 malignant cases vs four osteoporotic cases), epidural mass (24 vs 0), diffuse low signal intensity within the vertebral body on T1-weighted images (23 vs 12) and in the pedicles (24 vs four), high or inhomogeneous signal int...
215 citations
TL;DR: It is concluded that parathyroidectomy markedly improves lumbar spine BMD in patients with vertebral osteopenia and proposed that reduced cancellous bone density should become a new indication for surgery in primary hyperparathyroidism.
Abstract: Most patients with primary hyperparathyroidism have reduced radial and preserved vertebral bone density. We have identified a subset of patients with low lumbar spine bone density at diagnosis. This study assessed the effect of parathyroidectomy (undertaken based upon accepted surgical guidelines) or nonintervention on bone mineral density (BMD) in these patients. Twenty-two of 143 (15%) patients with mild primary hyperparathyroidism had lumbar spine BMD more than 1.5 SD below the mean for an age- and sex-matched population (z-score). Fourteen underwent parathyroidectomy, whereas 8 were followed with no intervention. All had annual BMD measurements for 4 yr after enrollment or after surgery. After parathyroidectomy, there was a brisk sustained rise in lumbar spine BMD [yr 1, 15 +/- 3% (P < 0.005); yr 4, 21 +/- 4% (P < 0.01)]. In those followed without surgery, BMD did not change significantly at any site. Postmenopausal women showed the same pattern as the cohort as a whole, i.e. increased BMD after surge...
162 citations
TL;DR: Preliminary results show that precision of the measurement of rotational and translational motion can be considerably enhanced by making allowance for radiographic distortional effects and by minimizing subjective influence in the measurement procedure.
161 citations
TL;DR: Significant osteoporosis in adults with CF results at least in part from a failure to accumulate bone mineral at a normal rate during skeletal growth and development, and the cause is likely multifactorial.
154 citations
TL;DR: The results suggest that resistance exercise is osteogenic and should be initiated early after heart transplantation, mostly due to decreases in trabecular bone.
TL;DR: A significant relationship exists between bone density and disc degeneration, bone density is a highly important factor in the performance of interbody stabilization, andDisc degeneration is of moderate importance in spinal motion.
Abstract: An in vitro biomechanical investigation in the human lumbar spine focuses on the functional significance of vertebral bone density and intervertebral disc degenerations.
TL;DR: The average distance from the projection point of the lumbar pedicle axis to the midline of the transverse process consistently varied at different levels, which may prove helpful in the placement of screws into the lUMAR pedicle.
Abstract: Study Design. This study defined the projection point of the lumbar pedicle on its posterior aspect and its relation to a reliable landmark and reported pedicle dimensions based on 50 lumbar spines. Objectives. To establish the best starting point for a pedicle screw for passing the screw down the center (axis) of the pedicle; to describe quantitatively the relations of the pedicle projection point to a reliable landmark; and to evaluate the linear and angular dimensions of the lumbar pedicle. Summary of Background Data. Posterior transpedicular screw fixation has been most widely used for management of the unstable lumbar spine. Several studies of pedicular anatomy exist, but little quantitative data regarding the location of the lumbar pedicle axis for each level have been reported. Methods. Fifty dry lumbar specimens (250 lumbar vertebrae) were obtained for study of the lumbar pedicle. Anatomic evaluation focused on determination of the projection point of the lumbar pedicle axis on the junction of the superior facet and the transverse process and measured the distance from the projection point to the midline of the transverse process for each level of the lumbar vertebrae. Pedicle dimensions, including linear and angular, also were measured. Results. Differences in dimensions between men and women were not found to be statistically significant. The average distance from the projection point to the midline of the transverse process consistently changed from L1 to L5. Above L4, the projection point for men and women averaged 3.9 mm for L1, 2.8 mm for L2, and 1.4 mm for L3 superior to the midline of the transverse process, respectively. At L4, the projection point was close to the midline of the transverse process (0.5 mm inferior). At L5, the projection point was an average of 1.5 mm inferior to the midline of the transverse process. Conclusions. The average distance from the projection point of the lumbar pedicle axis to the midline of the transverse process consistently varied at different levels. This information may prove helpful in the placement of screws into the lumbar pedicle.
TL;DR: It is confirmed that adolescent females with anorexia nervosa suffer losses not only in all compartments of body composition, but also demonstrate that the restoration of bone mass lags behind improvement in soft tissue compartments.
TL;DR: The overall results showed no statistical difference in outcome between the matched-pair groups, but the operated men fared significantly better than the non-operated men, and the functional status was very good in both groups and for both sexes.
Abstract: The prevailing opinion seems to accept that the natural course of lumbar spinal stenosis is one of progressive worsening, and that only surgery can check this development. In fact, the choice of treatment for lumbar spinal stenosis is still an open question. The aim of this study was to compare in the matched-pair format the outcome of surgically and non-surgically treated patients with lumbar spinal stenosis. The surgically treated group consisted of 496 patients who were operated on during the period 1974-1987 and 440 of whom were re-examined an average of 4.1 years after surgery. The non-surgically treated group consisted of 57 patients who were treated conservatively during the period 1980-1987 and were re-examined an average of 4.3 years after the start of treatment. The matching criteria were sex, age, myelographic findings, major symptom and duration of symptoms. We were able to form 54 similar matched-pairs from the surgically and non-surgically treated patients. Subjective disability was assessed using the Oswestry questionnaire and functional status was evaluated during the clinical examination. For statistical analysis the McNemar test and the paired Student's t-test were used. The overall results showed no statistical difference in outcome between the matched-pair groups, but the operated men fared significantly better than the non-operated men. The functional status was very good in both groups and for both sexes. In conclusion, conservative treatment of lumbar spinal stenosis should be considered for the patients with moderate stenosis. Controlled, prospective and randomized trials are needed to clarify better the choice of treatment in patients with lumbar stenosis.
TL;DR: Compressed vertebrae were analyzed for presence and characteristics of signal abnormality, altered vertebral contour, Schmorl's nodes, pedicular involvement, and contrast uptake and benign fractures were found.
Abstract: We reviewed spinal MR images of 58 patients with 98 compressed vertebrae. Benign (47 vertebrae) or malignant (51 vertebrae) etiology was established by biopsy or radiologic follow-up. Compressed vertebrae were analyzed for presence and characteristics of signal abnormality, altered vertebral contour, Schmorl's nodes, pedicular involvement, and contrast uptake. Statistical analysis was performed. Diffuse and homogeneous decrease in signal intensity on T1-weighted images, convex vertebral contour, involvement of the pedicles, and a lumbar location were more frequently observed in malignant fractures (P < .01). A thoracic location, lack of signal change, or a band-like abnormality and absence of pedicular involvement or contour abnormality characterized benign fractures (P < .01). Schmorl's nodes and enhancement did not help establish a diagnosis. When a constellation of MR criteria are applied, the accuracy of the diagnosis of malignant and benign vertebral compression fractures may reach 94%.
TL;DR: It is found that spondylodiscitis occurs in approximately 8% of patients with AS and these patients have early onset of disease, which means multiple-level lesions in the spine are not uncommon among those with spONDylodISCitis; lesions are usually asymptomatic.
Abstract: UNLABELLED Spondylodiscitis is well recognized in ankylosing spondylitis (AS), but little is known about its epidemiology. We therefore reviewed 147 consecutive patients with AS using lumbar and thoracic spine radiographs. For each patient with spondylodiscitis, two age- and sex-matched controls were selected. Twelve individuals (8%) had spondylodiscitis, affecting a total of 32 disc spaces: 10 thoracic, 22 lumbar. The mean age at onset was 21 +/- 4.1 yr, significantly younger than that of the controls (28.5 +/- 10.1 yr, P = 0.004). Half of the 12 patients had multiple lesions (between two and six levels). The most common site was the lower thoracic spine with additional lumbar spine involvement. Only two of the 12 patients (17%) had symptoms localized to the lesions. Neither trauma nor infection were considered to be causes of the spondylodiscitis. IN CONCLUSION (1) spondylodiscitis occurs in approximately 8% of patients with AS; (2) these patients have early onset of disease; (3) multiple-level lesions in the spine are not uncommon among those with spondylodiscitis; (4) lesions are usually asymptomatic.
TL;DR: Results indicated that subjects with severe osteoporosis in the distal radius also had severe degenerative changes in the discs and the facets; those with mild osteopOrosis showed a tendency to have a lesser degree of degenerativeChanges than the subjects without osteoporeosis.
Abstract: Degenerative changes in the spine, specifically disc degeneration and facet arthrosis, and osteoporosis are conditions that primarily affect the elderly and may significantly impact the quality of life. The relationship between osteoporosis and degenerative changes in the hip joint has been studied, but their correlation in the spine is not entirely clear. Two hundred ninety-four subjects older than 50 years of age were retrospectively studied for the existence of lumbar spinal degeneration and osteoporosis through radiologic examination for 3 clinical manifestations: (1) disc degeneration, (2) facet joint arthrosis, and (3) lumbar osteoporosis. Peripheral osteoporosis in the distal radius of the nondominant hand was measured using a single-photon bone absorptiometer. Results indicated that subjects with severe osteoporosis in the distal radius also had severe degenerative changes in the discs and the facets; those with mild osteoporosis in the distal radius showed a tendency to have a lesser degree of degenerative changes than the subjects without osteoporosis.
TL;DR: Evaluating the technical problems and fusion rate associated with the carbon fiber reinforced polymer implant cage for posterior lumbar interbody fusion found no intraoperative problems with the device and patients bar one maintained their immediately obtained postoperative disc height.
Abstract: Problems associated with posterior lumbar interbody fusion (PLIF) have traditionally included the need for donor bone, prolonged healing time of donor bone, the difficulty of cutting precise bony channels, the risk of retropulsion of graft, postoperative collapse of the bone graft, and pseudarthrosis. To avoid these problems a carbon fiber reinforced polymer implant cage has been developed to facilitate interbody fusion. The aim of the present study was to evaluate the technical problems and fusion rate associated with these new device for PLIF. Between April 1991 and December 1993, 65 pairs of these implant cages were sold in Sweden. They were traced to six hospitals, where they had been used in the treatment of 51 patients operated on at a total of 65 levels. All PLIF were supplemented with VSP (Variable Screw Placement) instrumentation. All medical records were evaluated and all patients were examined with plain radiographs taken at least 1 year after surgery. If that investigation did not show a clear fusion they were also evaluated with CT (18 patients, 27 levels). No intraoperative problems with the device have been reported; 44 patients (86%) and 58 levels (89%) achieved successful fusion. All patients bar one maintained their immediately obtained postoperative disc height. CT with 1-mm slices and sagittal reconstruction is most helpful if radiographs are difficult to interpret.
TL;DR: The phenotypic rescue of these genotypes shows that the Hoxa-11 and Hoxd-11 products are functionally equivalent and that extra doses of HoxD-11 can rescue HoxA-11 loss of function.
TL;DR: In this article, a burst fracture of the lumbar spine was followed for a mean of seventy-nine months (range, twenty-four to 192 months) after the injury.
Abstract: Fifty-five patients who had sustained a burst fracture of the lumbar spine were followed for a mean of seventy-nine months (range, twenty-four to 192 months) after the injury Thirty patients had been managed non-operatively with a short period of bed rest followed by protected mobilization The remaining twenty-five patients had been managed operatively: eight, with posterior arthrodesis with long-segment hook-and-rod fixation; eight, with posterior arthrodesis with short-segment transpedicular fixation; six, with posterior arthrodesis and instrumentation followed by anterior decompression and arthrodesis; and three, with anterior decompression and arthrodesis Thirty-six patients had been neurologically intact at the time of presentation and had remained so throughout the follow-up period No neurological deterioration or symptoms of late spinal stenosis were seen Isolated partial single-nerve-root deficits resolved regardless of the method of treatment Patients who had had a complete single or a multiple-nerve-root paralysis seemed to have benefited from anterior decompression Although the anatomical results as seen on the most recent radiographs were superior for the group that had been managed operatively with long posterior fixation or anterior and posterior arthrodesis, the most recent pain scores and the functional outcomes were similar for all treatment groups At the latest follow-up evaluation, some loss of spinal alignment was noted in the patients who had been managed with short transpedicular fixation; the alignment at the most recent follow-up examination was comparable with that in the patients who had been managed non-operatively For the patients who had had non-operative treatment, we were unable to predict the deformity at the time of follow-up on the basis of the initial diagnostic radiographs The clinical outcome was not related to the deformity at the latest follow-up evaluation On the basis of the results of our study, we recommend non-operative treatment for patients who do not have neurological dysfunction or who have an isolated partial nerve-root deficit at the time of presentation For patients who have a multiple-nerve-root paralysis, anterior decompression is indicated
TL;DR: Posterior fusion and instrumentation from the upper thoracic spine to L5 without anterior fusion provides adequate correction and control of spinal deformity for many patients with cerebral palsy and patients with significant growth remaining, or with severe deformities, may benefit by preliminary anterior release and fusion or inclusion of the pelvis and sacrum.
Abstract: We reviewed the clinical and technical outcomes of 25 patients with neuromuscular scoliosis, who were treated by Luque instrumentation and posterior spinal fusion from the upper thoracic spine to L5 between 1981 and 1988. A mean curve correction of 46% was obtained operatively with a mean 8° loss of correction during the follow-up period that ranged from 1.9 to 9.4 years (mean, 5.5). Pelvic obliquity was improved 50% from a mean of 16.1° to a mean of 8.1° in 24 patients for whom data were available. At final follow-up, the mean pelvic obliquity increased to 11.4° with only two patients increasing >8°. The cause for major postoperative increase in pelvic obliquity was continued anterior spinal growth with torsion of the fusion mass and was not related to changes limited to the L5-S1 motion segment. Posterior fusion and instrumentation from the upper thoracic spine to L5 without anterior fusion provides adequate correction and control of spinal deformity for many patients with cerebral palsy. Those patients with significant growth remaining, or with severe deformities, may benefit by preliminary anterior release and fusion or inclusion of the pelvis and sacrum.
TL;DR: Findings confirmed the long-held concept that the engorged extradural venous plexus in supine parturients decreases the effective capacity of the extradural and subarachnoid spaces.
Abstract: To clarify pregnancy-induced changes in soft tissue anatomy within the vertebral canal, we have studied magnetic resonance (MR) images of the lumbar spine in three women. In each subject, T2-weighted axial MR images were obtained both before pregnancy and at 32 weeks' gestation, and the paired images were compared. The extradural venous plexus was engorged significantly in supine parturients. In addition, the engorged extradural venous plexus displaced the dura away from the wall of the vertebral canal in a posterior direction, which resulted in a decrease in the volume of the cerebrospinal fluid in the dural sac. These findings confirmed the long-held concept that the engorged extradural venous plexus in supine parturients decreases the effective capacity of the extradural and subarachnoid spaces.
TL;DR: The study confirms the feasibility of using ultrasound to directly measure changes in the distances between the lumbar vertebrae using radiologic, stereophotographic, and magnetic resonance imaging techniques.
Abstract: Study Design This study measured the distances between the tips of the transverse processes of adjacent lumbar vertebrae (L1-L4) in the same subjects after 1 day of normal activities and again the next morning. Objectives To determine the feasibility of directly measuring the lumbar intervertebral distance using ultrasound and to determine the magnitude of the diurnal change in the intervertebral distance. Summary of Background Data A diurnal variation in height results from, in part, a decrease in height of the intervertebral discs with loading of the spine during the day. Previous estimates of the diurnal changes in disc height have used radiologic, stereophotographic, and magnetic resonance imaging techniques. No previous study has used ultrasound imaging. Methods Ultrasound was used to measure the distance between the tips of adjacent lumbar vertebral transverse processes. Measurements were made on six occasions in each of seven subjects after 6:00 PM in the evening and again the following morning before rising. Results The distance between the tips of adjacent transverse processes could be measured, within an individual, with a reproducibility of better than ± 7.5% coefficient of variation. Reproducibility of the measurement of the total distance between L1 and L4 was better than ± 4%. The intervertebral distances between L1 and L4 were significantly greater in the morning than in the evening. The average diurnal change in the total intervertebral distance L1-L4 was 5.3 mm. Conclusions The study confirms the feasibility of using ultrasound to directly measure changes in the distances between the lumbar vertebrae.
TL;DR: A case of primary vertebral epithelioid hemangioendothelioma occurring in the L2 vertebral body is presented and surgical treatment, pathological findings, imaging characteristics, and a review of the literature are presented.
Abstract: Epithelioid hemangioendothelioma is a recently described, rare vasoformative vascular tumor of variable biological behavior. Its principal sites of occurrence are soft tissues, liver, lung, and bone. There have been no formal case reports of this tumor occurring in the vertebral column, and there are no reports in the literature of surgical treatment for vertebral epithelioid hemangioendothelioma. We present a case of primary vertebral epithelioid hemangioendothelioma occurring in the L2 vertebral body. Surgical treatment, pathological findings, imaging characteristics, and a review of the literature are presented.
TL;DR: It is concluded that long-term administration of excessive doses of L-thyroxine to the adult rat preferentially affects femoral but not vertebral bone, manifested by decreased bone mineral density as well as increased gene expression markers for osteoblast and osteoclast activity in the femur.
Abstract: Recent studies suggest that thyroid-stimulating hormone suppressive doses of thyroid hormone decrease bone mass in humans and growing rats. To determine the long-term effects of excessive L-thyroxine administration on the femur and vertebrae in an adult rat model, 20 male Sprague-Dawley rats (20 weeks old) were randomized into two groups. Group 1 received L-thyroxine (20 micrograms/100 g body weight ip daily), and group 2 received normal saline ip daily for 20 weeks. Femoral and lumbar vertebral bone mineral density measurements were performed at 0, 6, 15, 18 and 20 weeks of treatment. After 20 weeks of treatment, total RNA was isolated from both femoral and lumbar bones. Northern hybridization was performed with 32P-labeled DNA probes for osteocalcin, osteopontin, alkaline phosphatase and tartrate-resistant acid phosphatase. Significant decreases in bone mineral density in the femur of L-thyroxine-treated rats were observed after 15 weeks (p < 0.03). Lumbar bone mineral density was not affected. Both osteoblast (osteocalcin, osteopontin, alkaline phosphatase) and osteoclast (tartrate-resistant acid phosphatase) gene expression markers were increased significantly in the femoral bone (p < 0.001), but not in the lumbar vertebrae of the L-thyroxine-treated rats. We conclude that long-term administration of excessive doses of L-thyroxine to the adult rat preferentially affects femoral but not vertebral bone. This is manifested by decreased bone mineral density as well as increased gene expression markers for osteoblast and osteoclast activity in the femur.
TL;DR: Investigating whether physical signs could predict the degree of hernia found at surgery found that there were only 2 physical signs of diagnostic value: lumbar range of motion and crossed Lasegue sign, and stepwise discriminant analysis showed these signs were the only significant parameters.
Abstract: In a prospective study of 163 consecutive patients operated on because they were thought to have lumbar disc hernia, the authors investigated whether physical signs could predict the degree of hernia (complete hernia, incomplete hernia, protruded disc, and normal disc) found at surgery. Stepwise discriminant analysis showed that there were only 2 physical signs of diagnostic value: lumbar range of motion and crossed Lasegue sign. By these signs, 74% of the uncontained hernias and 68% of the contained hernias could be correctly classified. Discrimination also was made between intact annuli (negative exploration and protruded disc) versus ruptured annuli (incomplete hernias and complete hernias). Again, lumbar range of motion and crossed Lasegue sign were the only significant parameters, predicting 71% of the ruptured annuli and 80% of the intact annuli. These 2 physical signs are important because the degree of the hernia is the most important prognostic factor for the outcome of lumbar disc surgery. The degree of the hernia also has an impact on the choice of invasive therapy: open surgery, percutaneous surgery, or enzymatic nucleolysis. Neurologic signs often were absent, showed low correlation to the degree of the hernia, and had a limited value for predicting the level of the hernia. However, they are important for the differential diagnosis in distinguishing between radicular and referred pain.
Journal Article•
TL;DR: It is suggested that chiropractic care may be a safe and helpful modality for the treatment of cervical and lumbar disc herniations and a random, controlled, clinical trial is called for to further substantiate the role of chiropractor care for the nonoperative clinical management of intervertebral disc herniation.
Book•
01 Jan 1996
TL;DR: Skull and mandible cervical spine, dural sac and spinal cords sternum, ribs, thoracic vertebrae and spinal cord conus medullaris, cauda equina, venous drainage the upper limb pelvic and lower limb bones.
Abstract: Skull and mandible cervical spine, dural sac and spinal cord sternum, ribs, thoracic vertebrae and spinal cord conus medullaris and cauda equina lumbar vertebrae and spinal cord paraspinal muscles and sacrum spinal cord, cauda equina, venous drainage the upper limb pelvic and lower limb bones.
TL;DR: Functional results showed a weak correlation with postoperative height loss of the intervertebral space and Influencing factors for the functional result were: postoperative compensation claim, age, and obesity.
Abstract: A total of 113 patients, excluding those with tumor, spondylitis, and idiopathic scoliosis, underwent anterior lumbar interbody fusion (ALIF) with autologous iliac crest graft between 1984 and 1991 at our department. The proportion of these who were failed back patients was higher than that reported in the literature. Evaluation of functional outcome was feasible in 80 patients, utilizing Oswestry and Marburg scores, which were closely intercorrelated. The overall results yielded an improvement in the Oswestry score of 35.7 percentage points. A subset of 52 patients who were evaluated twice, showed the same results at an average of 6.6 years as they did at 2.3 years following surgery. Functional results showed a weak correlation with postoperative height loss of the intervertebral space. Influencing factors for the functional result were: postoperative compensation claim, age, and obesity. Of the professional people involved, 19.4% did not return to any occupation. Patients satisfied with the result had significantly greater functional improvement. Younger patients with additional dorsal distraction prior to ALIF for reduction of severe spondylolisthesis fared better than patients with ALIF alone. The rate of complications was low and did not contribute to the postoperative functional result. On the basis of these results further prospective studies have been designed and are currently underway.