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Introduction:The lumbar vertebrae are affected in conditions such as congenital defects, degenerative diseases, accidents, and cancer metastasis. A thorough knowledge of the morphometry of typical and atypical lumbar vertebrae in adults of South Indian population is needed for lumbar spine surgeries. MaterialsandMethods: Adescriptive study was done on 200 dry lumbar vertebrae, of which 100 were typical and 100 were atypical lumbar vertebrae. The following dimensions of both typical and atypical lumbar vertebrae were measured with digital vernier calipers: anteroposterior and transverse diameters of the body; anterior and posterior body heights; anteroposterior and transverse diameters of vertebral foramen; height, breadth, and width of the laminae; length, height, and width of the pedicles; transverse processes and spinous process; distance between the two superior articular processes; and the distance between the two inferior articular processes. All the measurements were tabulated. The mean and standard deviation were calculated for each of the parameters and the results were statistically analyzed. Results: The anteroposterior and transverse diameters of the body, the height of the laminae on both sides, the length and height of the spinous process, and the distance between the superior articular facets were significantly longer in atypical lumbar vertebrae than that of typical lumbar vertebrae (P < 0.05). There was no significant difference in measurements between both sides. Conclusion: The dimensions of vertebral foramen, transverse processes, spinous processes, and distance between articular processes were different from the dimensions of previous studies. The morphometric data obtained will be useful for orthopedic procedures on the lumbar vertebrae in South Indian population
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Objective: To observe the effects of acupuncture at Yuan-Primordial and Luo-Connecting points by host-guest combination plus Tuina (Chinese therapeutic massage) on the third lumbar transverse process syndrome. Methods: A total of 88 patients with the third lumbar transverse process syndrome were selected and divided into an observation group and a control group according to the random number table method, with 44 cases in each group. The control group was treated with Tuina, and the observation group was treated with additional acupuncture at Yuan-Primordial and Luo-Connecting points by host-guest combination. The clinical efficacy of the two groups was compared after treatment. The changes in the scores of physical signs, Roland-Morris disability questionnaire (RMDQ), Oswestry disability index (ODI), Quebec back pain disability scale (QBPDS), and pain factors [including serum prostaglandin (PG) E2, neuropeptide Y (NPY), and matrix metalloproteinase-3 (MMP-3)] were observed. Results: After treatment, the total effective rate in the observation group was 93.2％, higher than 75.0％ in the control group; the difference between the two groups was statistically significant (P<0.05). Compared with those before treatment, the scores of physical signs and each low back pain scale, and the levels of serum pain factors in the two groups were decreased (P<0.05), and those in the observation group were lower than those in the control group (P<0.05). Conclusion: Acupuncture at Yuan-Primordial and Luo-Connecting points by host-guest combination plus Tuina is effective in the treatment of the third lumbar transverse process syndrome; it can improve the patient's physical signs, relieve low back pain, and reduce the levels of serum pain factors.
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OBJECTIVE@#To observe the clinical efficacy differences between acupuncture combined with hydro-acupuncture and acupuncture alone for transverse processes syndrome of the third lumbar vertebra.@*METHODS@#One hundred patients were randomly divided into an observation group and a control group, 50 cases in each one. The patients in the control group were treated with regular acupuncture at Weizhong (BL 40), points, Jiaji (L～L) and Shenshu (BL 23); the acupuncture was given once a day, six treatments per week for consecutive 2 weeks. Based on the acupuncture treatment in the control group, in the observation group the No.5 injection needle was applied to relieve the tenderness points on the transverse process and articular process of the third lumbar vertebra, followed by hydro-acupuncture with injection (1 mL per point, 7 days per injection for 2 weeks). The visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) scale and Oswestry disability index (ODI) were observed before treatment, after treatment and during six-month follow-up visit in the two groups. In addition, the clinical efficacy was compared between the two groups.@*RESULTS@#Forty-eight patients completed treatment and 2 patients dropped off in the observation group, while 47 patients completed treatment and 3 patients dropped off in the control group. The total effective rate was 91.7% (44/48) in the observation group, which was significantly superior to 76.6% (36/47) in the control group (<0.05). Compared before treatment, the VAS and ODI in the two groups were reduced after treatment and during six-month follow-up visit, while the JOA was increased (all <0.05); the VAS and ODI in the observation group was lower than that in the control group, while JOA in the observation group was higher than that in the control group (all <0.05).@*CONCLUSION@#Acupuncture combined with hydro-acupuncture are effective for transverse processes syndrome of the third lumbar vertebra, and could significantly improve lumbar function and relieve the pain symptoms, which is superior to regular acupuncture.
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Humans , Acupuncture , Acupuncture Points , Acupuncture Therapy , Case-Control Studies , Low Back Pain , Lumbar Vertebrae , Treatment OutcomeABSTRACT
Objective To observe the clinical efficacy of tendons layer overall release treatment by needle knife for the third lumbar transverse process syndrome (TLTPS). Methods Totally 66 cases of TLTPS patients were divided into control group and experimental groups by using random number table method, with 33 cases in each group. L3 spinous process opened 3 cm looking for tenderness. Control group received lumbar transverse pressure tender point knife release treatment. On the basis of control group, experimental group received tendons layer overall release treatment by needle knife. Both control group and experimental group received treatment once. VAS and ODI before treatment and after treatment of 1, 2 and 3 months were observed. Clinical efficacy was evaluated. Adverse reactions and complications were observed. Results The experimental group and control group lost 1 and 2 cases, respectively. Compared with before treatment, the VAS and ODI in both groups after treatment decreased (P<0.05). After treatment, the VAS and ODI in the experimental group were lower than those of the control group, with statistical significance (P<0.05). The total effective rate of clinical efficacy was 96.88% (31/32) in the experimental group and 93.55% (29/31) in the control group, with experimental group better than the control group (Z=-2.756, P=0.006). There were no adverse reactions or complications in both groups. Conclusion Tendons layer overall release treatment combined with lumbar transverse pressure tender point knife release treatment for TLTPS can significantly improve the clinical efficacy of TLTPS, with long effects.
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Objective To investigate the successful rate and the therapeutic effect of loosening posterior tubercle of cervical transverse process with CT-guided insertion or blind insertion of small needle knife for cervical spondylotic radiculopathy. Methods Ninety patients with cervical spondylotic radiculopathy were divided into CT-guided insertion group and blind insertion group in the admission order using the random number table method, 45 cases in each group. CT-guided insertion group adopted the insertion of small needle knife following by the guide of CT, and the blind insertion group adopted the insertion of small needle knife following by cervical bony landmarks and muscles. After insertion, the position of the small needle knife in patients of the two groups was located by CT scan. If the needle knife did not arrive to the foci, it will be inserted again following by the guide of CT till successful insertion and location. The successful rate for the two times of insertion was calculated, and the pain scores were evaluated by visual analogue scale(VAS). Results(1) The successful rate for the first insertion of CT-guided insertion group was 73.3％, and that of the blind insertion group was 47.8％, the difference being significant(P < 0.01). The successful rate for the second insertion of CT-guided insertion group was 92.2％, and that of the blind insertion group was 80.0％, the difference being significant (P<0.01). (2) After treatment for one week, pain VAS scores of the two group were decreased (P < 0.01 compared with those before treatment) , and the decrease in the CT-guided insertion group was more obvious than the blind insertion group (P < 0.05). Conclusion CT-guided insertion makes the small needle knife therapy be more accurate and safer, ensures much better therapeutic effect, and brings less pain in the patients.
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Objective To observe the effect of heat needle treatment on the inflammatory reaction in the damaged tissues of rats with the third lumbar transverse process syndrome. Methods Ninety Sprague-Dawley rats were randomly divided into 6 groups, namely normal group, model group, drug group, heat needle group, conventional acupuncture group and warming acup-moxibustion group, 15 rats in each group. The rat model of the third lumbar syndrome was established by embedding gelatin sponge. Two weeks later, the rats in various groups were given corresponding treatment respectively. Before treatment and on the 7th, 14th and 28th day of treatment, the blood samples were collected from jugular vein, and then the serum inflammatory cytokines of tumor necrosis factor alpha (TNF-α), interleukin (IL)-1β and IL-6 were detected by enzyme-linked immunosorbent assay (ELISA). On the 28th day of treatment, all of the rats were sacrificed, the expression levels of TNF-α, IL-1βand IL-6 mRNA in the muscle tissue were detected by reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR), and the pathological changes in local muscle tissue were observed by HE staining method. Results The serum contents of the inflammatory cytokines of TNF-α, IL-1β and IL-6 in the model group and treatment groups after modeling were significantly higher than those in the normal group (P < 0.05). After treatment, the contents of TNF-α, IL-1β and IL-6 in various treatment groups were decreased significantly as compared with those in the model group, and the decrease was most obvious in the heat needle group. The expression levels of TNF-α, IL-1β and IL-6 mRNA in muscle tissues of drug group, heat needle group, conventional acupuncture group and warming acup-moxibustion group were lower than those of the model group (P < 0.05), and the heat needle group had the lowest levels. HE staining results showed that heat needle group had milder inflammatory reaction and better muscle fiber structure than the model group. Conclusion Heat needle treatment can improve the local inflammatory response and promote the repair of tissue damage through decreasing the expression levels of inflammatory cytokines of TNF-α, IL-1βand IL-6.
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<p><b>OBJECTIVE</b>To explore the effects differences for the third lumbar transverse process syndrome between acupuncture mainly at zygapophyseal joint and transverse process and conventional acupuncture.</p><p><b>METHODS</b>Eighty cases were randomly assigned into an observation group and a control group, 40 cases in each one. In the observation group, patients were treated with acupuncture at zygapophyseal joint, transverse process, the superior gluteus nerve into the hip point and Weizhong (BL 40), and those in the control group were treated with acupuncture at Qihaishu (BL 24), Jiaji (EX-B 2) of L-L, the superior gluteus nerve into the hip point and Weizhong (BL 40). The treatment was given 6 times a week for 2 weeks, once a day. The visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) low back pain score and simplified Chinese Oswestry disability index (SC-ODI) were observed before and after treatment as well as 6 months after treatment, and the clinical effects were evaluated.</p><p><b>RESULTS</b>The total effective rate in the observation group was 95.0% (38/40), which was significantly higher than 82.5% (33/40) in the control group (<0.05). After treatment and at follow-up, the VAS score and SC-ODI score were lower and JOA score was higher than those before treatment in the two groups (all<0.05), with better results in the observation group (all<0.05).</p><p><b>CONCLUSIONS</b>Acupuncture mainly at zygapophyseal joint and transverse process for the third lumbar transverse process syndrome achieves good effect, which is better than that of conventional acupuncture on relieving pain, improving lumbar function and life quality.</p>
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Supernumerary lumbar ribs are usually asymptomatic and discovered incidentally during routine diagnostic radiography. During a routine inventory of the research skeletal repository at the University of the Witwatersrand, a rare case of bilateral supernumerary ribs on the first lumbar vertebra was observed. The skeletal specimen belonged to a 70-year-old African male whose recorded cause of death was esophageal carcinoma. Plain radiography revealed bilateral joint cavities between the transverse processes of the first lumbar vertebra and the supernumerary ribs. Clinically, supernumerary lumbar ribs may present with pain of the renal angle, cause confusion during enumeration of the vertebral levels on radiographs, and may be misinterpreted as fractures, kissing osteophytes, and/or calcification of abdominal vasculature.
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Adult , Aged , Humans , Male , Cause of Death , Joints , Osteophyte , Radiography , Ribs , Skeleton , SpineABSTRACT
Objective To compare effectiveness,performance,onset time and complications between ultrasound-guided cervical transverse process block and interscalene brachial plexus block in patients undergoing proximal humeral surgeries.Methods Sixty patients,27 males and 33 females, aged 18-70 years,scheduled for proximal humeral surgeries were randomly divided into two groups. They were given either cervical transverse process block (group T,n =30)or ultrasound-guided in-terscalene brachial plexus block (group I,n =30).All patients received a total of 8 ml of 0.5% ropiv-acaine.The performance, anesthetic onset time, the side effects and block success rate were evaluated.Results Block procedure was quicker in group T than in group I [(8.73 ±3.1 7)min vs. (14.40±8.21)min,P <0.01].The severity of diaphragmatic paralysis in group T was significantly lower than in group I (P <0.01).The ultrasound-guided cervical transverse process block was more effective than the interscalene brachial plexus block in patients undergoing proximal humeral surgeries (100% vs.80%,P <0.05).Conclusion The ultrasound-guided cervical transverse process block has a higher success rate and fewer incidence of diaphragmatic paralysis than the interscalene brachial plexus block in patients undergoing proximal humeral surgeries.
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Objective To explore the uncinate-transverse hole spacing developmental patterns and aging characteristics by means of studying the teenagers aging from 6~20 years old,and provide the basis for image analysis of the treatment and prevention of cervical spondy-losis. Method the 66 adolescents without trauma nor problems of nervous system were selected to do thin spiral CT scan(0. 625 ~1. 25 mm) ,the range was C1 ~T1 . The original data in the form of DICOM are analyzed according to gender and age. Results There was no sig-nificant difference in gender and different sides. Overall,the physical development of human increases gradually with age and has some signifi-cant differences. Conclusion There exists a close relationship between cervical hook-transverse process and the incidence of vertebral artery type and nerve root type cervical spondylosis.
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Purpose To investigate the diagnostic value of high-resolution CT reconstruction techniques on the same slice in hypertrophy of transverse process of the fifth lumbar vertebra (HTPL5V), and to provide a basis for clinical diagnosis and treatment. Materials and Methods Twenty-two cases of clinically diagnosed HTPL5V and 20 normal adults were examined with GE LightSpeed 16-slice spiral CT (36 cases) and Philips iCT 256-slice (6 cases). L5 transverse process and the fifth lumber nerve were reconstructed and observed on the workstations. Results In 22 cases of HTPL5V, there were 26 pseudarthrosis formation and 2 sides with L5 transverse process touching the sacral ala. In 28 sides the iffth lumber nerve traveled through false foramina of the HTPL5V including 6 cases of bilateral compression and 16 cases of unilateral compression. In 21 cases, the nerve was compressed by hyperosteogeny on 27 sides (96.4%) and 1 side due to stenosis (3.6%). On 25 sides (89.3%) the compressed nerves were curved in shaper. There was bulging and/or herniated lumbar disc on 9 sides in 7 cases (32.1%). Conclusion High-resolution CT reconstruction techniques can demonstrate the iffth lumbar nerve of HTPL5V and provide evidence for clinical diagnosis and treatment.
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Osseous bridging between lumbar transverse processes is an uncommon condition that may cause low back pain. In most cases, its etiology is alleged to be trauma to the back and only rarely has a congenital origin been indicated. Furthermore, most reported cases involved adults, the majority of whom were middle-aged. Here, the authors describe the case of the youngest girl reported to date with congenital transverse process bridging. As far as the authors' knowledge, there has been no report of congenital bridging of transverse processes in children or adolescents in Korea.
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Adolescent , Adult , Child , Humans , Korea , Low Back PainABSTRACT
Pyogenic spondylitis involving only the posterior element of a vertebra is rare. To the best of our knowledge, there have been no reports of osteomyelitis of the transverse process. We report here on a 45-year-old male with a one month history of swelling associated with lower back pain. The magnetic resonance imaging showed a paraspinal soft tissue mass, and computed tomography revealed a fine osteolytic lesion in the right transverse process of the 5th lumbar spine, and this was all consistent with chronic osteomyelitis. A mixed staphylococcal infection was identified. Open drainage, resection of the transverse process and intravenous injection of anti-staphylococcal antibiotics resolved the back pain and reduced the erythrocyte sedimentation rate to normal. Pyogenic osteomyelitis of the transverse process is extremely rare, which can cause a misdiagnosis or a delayed diagnosis. Careful consideration of this disease is needed when evaluating patients who complain of back pain.
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Humans , Male , Middle Aged , Chronic Disease , Lumbar Vertebrae , Magnetic Resonance Imaging , Osteomyelitis/diagnosis , Spinal Diseases/diagnosis , Staphylococcal Infections/diagnosis , Tomography, X-Ray ComputedABSTRACT
@#Objective To investigate the relationship between the pedicle and the transverse process in the thoracic and lumbar verte-brae. Methods 111antertior-posterior images of the lumbar vertebra and 111antertior-posterior images of the thoracic vertebra were chosen and lines were drawn between two pedicle centers of the same segment. The transverse process was divided into 4 equal parts by horizontal lines. The corresponding study was performed on the relationship between the pedicle and the transverse pro cess. Results Most of the T1～T2 pedicles corresponded to the midline of the transverse process. A large number of the T3～T11 pedicles corresponded to the upper 1/3 of the transverse process and the others corresponded to the upper margin, upper 1/4 or the midline of the transverse process. Most of the T12 pedicles corresponded to the upper margin of the transverse process. A large number of the L1, L2 and L5 pedicles corresponded to the upper 1/3 of the transverse process. A large number of the L3 and L4 pedicles corresponded to the midline of the transverse process. Conclusion The thoracic and lumbar pedicles have a multiform corresponding relationship with the transverse process.
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Authors performed extrapedicular screws fixation in thoracic spines. Because patient had very narrow thoracic pedicles, classical transpedicular screws fixation could not be accomplished. In case of narrow thoracic pedicles, extrapedicular screws fixation would be a good alternative technique. We describe here a method for thoracic extrapedicular screws fixation.
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Humans , SpineABSTRACT
BACKGROUND: The angle and depth from the insertion point to the brachial plexus (BP) and C6-7 intervertebral foramen (IF) was examined to prevent critical complications of an interscalene brachial plexus block (ISBPB), such as an epidural or subdural injection of local anesthetics and spinal cord injury. METHODS: Thirty patients (female = 12, male = 18), aged 20-64 years, undergoing shoulder or upper limb surgery were examined. ISBPB was performed at the interscalene groove intersecting the extended transverse line from the cricoid cartilage. A needle was then advanced towards the C6 transverse process (TP) and C6-7 IF under the C-arm fluoroscopic guidance. The depth and angle of the needle path intersecting the sagittal plane from the skin insertion point to BP, transverse process (TP) and IF were measured. RESULTS: The mean depth of the needle from the insertion point to BP, TP and IF were 2.6 +/- 0.3 cm, 3.2 +/- 0.4 cm, 3.7 +/- 0.3 cm in the female patients, and 2.7 +/- 0.3 cm, 3.6 +/- 0.5 cm, 4.1 +/- 0.3 cm in the male patients. The mean angle of the needle path at the same point was 56.0 +/- 7.2o (range, 42.0-65.0degrees), 54.2 +/- 5.8degrees, 53.7 +/- 4.4degrees in the female patients, and 59.3 +/-8.3degrees (45.0-75.0degrees), 54.0 +/- 6.3degrees, 54.9 +/- 4.2degrees in male patients. There were significant differences in the depth from the skin to the TP and IF between males and females. CONCLUSIONS: These findings are expected to provide a guideline for more accurate needle placement and successful block during ISBPB.
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Aged , Female , Humans , Male , Anesthetics, Local , Brachial Plexus , Cricoid Cartilage , Epidural Space , Needles , Shoulder , Skin , Spinal Cord , Upper ExtremityABSTRACT
BACKGROUND: The angle and depth from the insertion point to the brachial plexus (BP) and C6-7 intervertebral foramen (IF) was examined to prevent critical complications of an interscalene brachial plexus block (ISBPB), such as an epidural or subdural injection of local anesthetics and spinal cord injury. METHODS: Thirty patients (female = 12, male = 18), aged 20-64 years, undergoing shoulder or upper limb surgery were examined. ISBPB was performed at the interscalene groove intersecting the extended transverse line from the cricoid cartilage. A needle was then advanced towards the C6 transverse process (TP) and C6-7 IF under the C-arm fluoroscopic guidance. The depth and angle of the needle path intersecting the sagittal plane from the skin insertion point to BP, transverse process (TP) and IF were measured. RESULTS: The mean depth of the needle from the insertion point to BP, TP and IF were 2.6 +/- 0.3 cm, 3.2 +/- 0.4 cm, 3.7 +/- 0.3 cm in the female patients, and 2.7 +/- 0.3 cm, 3.6 +/- 0.5 cm, 4.1 +/- 0.3 cm in the male patients. The mean angle of the needle path at the same point was 56.0 +/- 7.2o (range, 42.0-65.0degrees), 54.2 +/- 5.8degrees, 53.7 +/- 4.4degrees in the female patients, and 59.3 +/-8.3degrees (45.0-75.0degrees), 54.0 +/- 6.3degrees, 54.9 +/- 4.2degrees in male patients. There were significant differences in the depth from the skin to the TP and IF between males and females. CONCLUSIONS: These findings are expected to provide a guideline for more accurate needle placement and successful block during ISBPB.
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Aged , Female , Humans , Male , Anesthetics, Local , Brachial Plexus , Cricoid Cartilage , Epidural Space , Needles , Shoulder , Skin , Spinal Cord , Upper ExtremityABSTRACT
[Objective] To gain more insight into the presentation,diagnosis of Bertolotti's syndrome and to investigate the indications,the procedure and the early clinical results of minimally invasive transverse process plasty.[Methods]Thirteen cases(Santavirta Type I)with Bertolotti's syndrome underwent minimally invasive transverse process plasty under MED X-tube(Medtronic Sofamor)from Apr.2006 to Dec.2008.The Visual Analogue Scale(VAS),Modified Oswestry Disability Index(ODI)score and subjective sensation of patients were recorded to evaluate the function.[Results]The operation blood loss was from 120 ml to 800 ml and operative time was from 60 to 280 minutes,average 115minutes.There was no severe complication.Nine cases were followed up for 10 to18 months,average 13.6 months.The VAS decreased from(6.7?2.2)before operation to(2.2?0.7)one week after operation and(2.8?0.9)three months after operation.ODI score decreased from(27.8?3.6)before operation to(5.9?2.2)three months after operation.The results were excellent in 10 case and good in 3 cases.[Conclusion]Minimally invasive transverse process plasty is an effective method for Bertolotti's syndrome,especially for Santavirta type I.It shows less blood loss and injury and deserves to be spreaded.Disectomy is recommended in one stage if the patient is complicated with disc herniation.
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Objective To evaluate the relationship between transverse process fractures of lumbar spine and blunt abdominal trauma.Methods 169 cases of blunt abdominal trauma were reviewed.Number and type of lumbar transverse process fractures associated intra-abdominal injuries were recorded.Results 148 fractures in 81 cases showed transverse process fractures on CT (single fractures in 43,multiple fractures in 38).Of them,the fractures were at right-sided in 28 patients,left-sided in 33 and bilateral in 20.Transverse process fractures of L 1 vertebra were most common(n=60).Transverse process fractures were associated with abdominal trauma in 15 cases (18%), both was statistically significant (?
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BACKGROUND: Stellate Ganglion Block (SGB) is a procedure performed frequently in pain clinics. However the palpation of cervical transverse processes is difficult in patients with short and thick necks. In these cases the neck crease is used as an indicator of cervical level in my department. The aim of this study is to evaluate the usefulness of neck creases as an indicator of C6 level. METHODS: We observed fifty patients that experienced nerve blockade due to chronic pain or cancer-related pain. Patients laid down in supine position. They slightly elevated their chins and opened their mouths to relax neck muscles. A) The radiopaque line was laid in accordance with neck crease below the thyroid cartilage. B) Simultaneously, the radiopaque indicator was laid on the skin above the most prominent tubercle by palpation. We took an x-ray picture of the neck. RESULTS: The probability that the lines crossed over C5, C6 and C7 were 16%, 71%, and 12% respectively. The probability that the most prominent tubercle accorded with C5, C6 and C7 were 16%, 69% and 14% respectively. There was no significant difference between method A) and B). CONCLUSIONS: The most prominent palpable tubercle of the cervical spine can be used as an indicator of C6, but we can use the neck crease as a good indicator of C6 in cases where the neck can't be palpated well.