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OBJECTIVE@#To investigate the clinical efficacy and safety of percutaneous foraminal endoscopy in the treatment of lumbar lateral recess stenosis in elderly.@*METHODS@#The clinical data of 31 elderly patients with lumbar lateral recess stenosis treated by percutaneous foraminal endoscopic decompression from March 2018 to August 2019 were retrospectively analyzed. Including 16 males and 15 females, aged from 65 to 81 years with an average of (71.13±5.20) years, the course of disease ranged from 3 months to 7 years with an average of (14.36±6.52) months. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to assess clinical symptom and functional status before operation and 1, 6, 12 months after operation. At the final follow-up, the modified Macnab standard was used to evaluate clinical efficacy.@*RESULTS@#All patients were completed the operation successfully. The operation time was from 75 to 120 min with an average of (97.84±11.22 ) min. All 31 patients were followed up from 12 to 28 months with an average of (17.29±5.56) months. Postoperative lumbago-leg pain VAS and ODI were significantly improved at 1, 6, and 12 months(P<0.01). At the final follow-up, according to the modified Macnab standard to evaluate the effect, 23 got excellent results, 5 good, 3 fair. One patient had severe adhesions between peripheral tissues and nerve root, and postoperative sensory abnormalities in the lower extremities were treated conservatively with traditional Chinese medicine and neurotrophic drugs, which recovered at 2 weeks after surgery. No complications such as nerve root injury and infection occurred.@*CONCLUSION@#The intervertebral foraminal endoscopy technique, which is performed under local anesthesia for a short period of operation, ensures adequate decompression while minimizing complications, and is a safe and effective surgical procedure for elderly patients with lumbar lateral recess stenosis.
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Male , Female , Humans , Aged , Infant , Constriction, Pathologic/surgery , Spinal Stenosis/surgery , Decompression, Surgical/methods , Retrospective Studies , Lumbar Vertebrae/surgery , Endoscopy/methods , Treatment OutcomeABSTRACT
Objective To analyze the changes in morphology of intervertebral foramina in patients with cervical spondylotic radiculopathy (CSR) treated with fixedpoint lateral flexion and rotation manipulation based on three-dimensional (3D) reconstruction technology, so as to provide references for the effectiveness of manipulation treatment. MethodsForty patients with CSR were treated with fixed point lateral flexion and rotation manipulation once every other day for a total of 7 times and 2 weeks as a course of treatment. CT data of the patients before and after treatment were analyzed by using multifunctional CT, Mimics 21.0, Geomagic and SolidWorks 2017. The area of the intervertebral foramen, anterior and posterior diameter of the intervertebral foramen, upper and lower diameter of the intervertebral foramen were measured before and after treatment, as well as the infrared thermal imaging temperature differences of the bilateral neck and shoulder, front and back of the upper limb, and the VAS scores of the patients were observed before treatment, 7 d after treatment, 14 d after treatment and 1 month follow-up. Results Foraminal area, anterior and posterior diameters, upper and lower diameters of 40 patients were improved after treatment, and the temperature differences of infrared thermal imaging of patients before and after treatment were statistically significant. The VAS score of the patients decreased progressively. Conclusions Fixed point lateral flexion manipulation can significantly improve the shape of the intervertebral foramen in patients with CSR, so as to achieve the treatment purpose of relieving nerve compression.
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OBJECTIVE@#To compare the clinical efficacy and safety among three different entry points of needle knife, including tenderness point, intervertebral foramen point and articular process node, for lumbar disc herniation (LDH).@*METHODS@#A total of 105 patients with LDH were randomly divided into a tenderness point group (35 cases, 1 case dropped off ), an intervertebral foramen point group (35 cases) and an articular process node group (35 cases, 1 case dropped off ). In the three groups, the needle knife was given at positive tenderness points of lumbosacral and hip, the external point of intervertebral foramen and the node of vertebral joint process respectively, once a week for a total of 4 times. The scores of Japanese Orthopaedic Association (JOA), Oswestry disability index (ODI), visual analogue scale (VAS) were recorded before treatment, 2 weeks and 4 weeks into treatment, and 3 months follow-up after treatment, and the clinical efficacy and safety was observed.@*RESULTS@#Compared before treatment, the JOA scores in each group were increased 2, 4 weeks into treatment and in the follow-up (P<0.05); 4 weeks into treatment and in the follow-up, the JOA scores in the tenderness point group and the articular process node group were higher than those in the intervertebral foramen point group (P<0.05). Compared before treatment, except for ODI score 2 weeks into treatment in the intervertebral foramen point group, the ODI and VAS scores in each group were decreased 2, 4 weeks into treatment and in the follow-up (P<0.05), and the ODI scores in the tenderness point group and the articular process node group were lower than those in the intervertebral foramen point group (P<0.05). In 2 weeks into treatment, the VAS scores in the tenderness point group and the articular process node group were lower than those in the intervertebral foramen point group (P<0.05); in 4 weeks into treatment and follow-up, the VAS scores in the tenderness point group were lower than the other two groups (P<0.05). After treatment, the clinical efficacy of each group was similar (P>0.05); during the follow-up, the total effective rate in the tenderness point group was higher than that in the intervertebral foramen point group (P<0.05). There were no serious adverse events in each group.@*CONCLUSION@#The three different entry points of needle knife all could improve the symptoms of patients with LDH. The comprehensive effect of improving the subjective symptoms, lumbar function, pain degree and long-term curative effect is better in the tenderness point group.
Subject(s)
Humans , Intervertebral Disc Displacement/therapy , Lumbar Vertebrae , Lumbosacral Region , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: Lumbar disc herniation is mostly accompanied by ipsilateral compression symptoms caused by the pressure of herniated portion on the ipsilateral nerve root. Rare cases are reported to present with contralateral compression symptoms. So there is currently no specific classification and nomenclature for this type of lumbar disc herniation, which is referred to as lumbar disc herniation with contralateral symptoms in this article. OBJECTIVE: To investigate the efficacy of endoscopic lumbar nucleus pulposus removal for unilateral versus bilateral decompression in patients with lumbar disc herniation presenting with contralateral symptoms. METHODS: Forty patients with contralateral symptomatic lumbar disc herniation who underwent endoscopic lumbar nucleus pulposus surgery from January 2015 to December 2018 were enrolled in enrolled for retrospective analysis. According to the different decompression methods, the patients were randomly divided into an ipsilateral decompression group (n=20) and a bilateral decompression group (n=20). The visual analogue scale (VAS) and Japanese Orthopedics Association (JOA) scores of the lumbar and lower extremities before and at 3, 6, and 12 months after surgery were recorded. Clinical efficacy was evaluated by the modified Macnab standard at 12 months after surgery. Dynamic X-rays of the lumbar spine were used to evaluate lumbar stability. RESULTS AND CONCLUSION: All the 40 patients were followed up for 12-20 months, with an average of 16 months. There were no complications such as dural sac tear and intervertebral space infection in the two groups. The pain in the lower back and lower extremities were significantly relieved in both groups. The postoperative JOA score was significantly higher than that before surgery; and the postoperative VAS scores of the waist and lower extremities were significantly lower than those before surgery (P < 0.05). The VAS and JOA scores in the bilateral decompression group were significantly superior to those in the unilateral decompression group (P < 0.05). The improved Macnab evaluation at 12 months after surgery showed that the excellent and good rate was 70% in the unilateral decompression group, and 95% in the bilateral decompression group, with significant difference between two groups (P < 0.05). Lumbar spine dynamic X-rays at 12 months after surgery showed no lumbar instability or slippage in the two groups. For patients with lumbar disc herniation presenting with contralateral symptoms who underwent percutaneous transforaminal lumbar nucleus pulposus removal, pain symptoms eased off after treatment with two decompression methods, but the bilateral decompression had better postoperative recovery compared with the unilateral decompression.
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OBJECTIVE@#To evaluate the mid-term efficacy of radiofrequency ablation of nucleus pulposus by intervertebral foramen endoscopy BEIS technique in the treatment of lumbar spine surgery failure syndrome over 60 years old.@*METHODS@#The clinical data of 40 patients over 60 years old with lumbar spine surgery failure syndrome admitted from January 2010 to January 2015 were retrospectively analyzed. Among them, there were 34 males and 6 females, aged from 60 to 76 years old with an average of 66 years, the courses of disease ranged from 10 months to 4 years. The patients were divided into two groups (BEIS group and revision group) according to the different surgery. The intervertebral foramen endoscopy BEIS technique and the transforaminal lumbar interbody fusion (TLIF) were performed in BEIS group and revision group respectively. There was no significant difference in general data such as sex, age, course of disease, surgical segment between two groups(>0.05). The operation time, intraoperative bleeding volume, bed rest time after operation and hospitalization time were observed between two groups. At preoperative, postoperative 1 month, 1 year, 3 years, visual analogue scale(VAS) and Japanese Orthopaedic Association Score(JOA) were used to compare the efficacy.@*RESULTS@#The operation time, intraoperative bleeding volume, bed rest time after operation and hospitalization time in BEIS group were (60.2±10.3) min, (60.1±4.5) ml, (2.2±1.5) d, (4.04±1.40) d, respectively, which were significantly lower than those of revision group (<0.05). The VAS and JOA scores of the two groups at different time after operation were significantly improved (<0.05), and there was statistically significant difference between two groups (<0.05).@*CONCLUSIONS@#Radiofrequency ablation of nucleus pulposus by intervertebral foramen endoscopy BEIS technique is more effective than TLIF revision in the treatment of lumbar spine surgery failure syndrome over 60 years old. It has advantages of shorter operation time, less bleeding, shorter bed rest after operation and hospitalization time, and is worthy of clinical promotion.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Endoscopy , Lumbar Vertebrae , Retrospective Studies , Spinal Fusion , Treatment OutcomeABSTRACT
Background and objective: The dimensions of intervertebral foramen can be altered by various factors. Theobjective of the present study was to measure the dimensions of L1-S1 intervertebral foramen and compare themon both sides and in both sexes.Methodology: The present study was conducted on 10 human cadavers (100 intervertebral foramina), collectedfrom the department of Anatomy, Mysore medical college and research institute, Mysore. Descriptive statistics,ANOVA (Analysis of Variance) and Independent t- test were used appropriately.Results: It was observed that the foramen height was more than foramen length (antero-posterior length) at alllevels. The foraminal height and length at the lower lumbar levels were significantly smaller than those at theupper levels. The difference observed in the morphometry of foramen on right and left side; and with respect togender was statistically not significant.Conclusions: The present study describes the normal parameters of intervertebral foramen.
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The intervertebral foramen is formed by two adjacent vertebrae and an intervertebral disc. Previous studies examining the foramen have been performed using various methods. The author obtained characteristics of the intervertebral foramen based on silicon mold. The author used 18 cadavers and dissected the lumbar intervertebral foramen. First, positional levels of the spinal nerve in the intervertebral foramen were measured. Second, after being removed all tissues covering the intervertebral, bony foramen was filled with melted silicon to mold the cross section. Subsequently, the solidified silicon mold was removed and stamped on a paper. The paper was scanned and analyzed area, perimeter, height and width of the intervertebral foramen on a computer. Area (average, 9.43 mm²) and perimeter (average, 48.02 mm) did not show any statistical significant pattern for any lumbar vertebral levels. However, the height and width significantly differed at the fifth lumbar vertebra, which had the shortest height (the fifth, 13.00 mm; average, 15.78 mm) and longest width (the fifth, 8.61 mm; average, 7.87 mm), although there were similar patterns in case of area and perimeter of the first to fourth lumbar vertebra. Height had a decrease tendency while width had an increase tendency both from the second to fifth lumbar vertebra. Spinal nerves went through near the intervertebral disc level from the first to fourth lumbar vertebra, although they passed below the disc at the fifth level. This study provides a different view of methodology for the 3-dimensional aspect for the intervertebral foramen. Results of this study may indicate that height and width of the intervertebral foramen changed along all lumbar vertebral levels; nevertheless, area and perimeter of the intervertebral foramen remained constant.
Subject(s)
Cadaver , Fungi , Intervertebral Disc , Silicon , Spinal Nerves , SpineABSTRACT
Objective To evaluate the clinical effect of percutaneous intervertebral foramen and TLIF in the treatment of extreme lateral lumbar disc herniation and the SF-36 score.Methods A total of 90 patients with extreme lateral lumbar disc herniation admitted in our hos-pital from March 2015 to March 2017 were selected as the subjects,who were divided into the control group ( traditional therapy) and the study group(percutaneous intervertebral foramen treatment), according to the different surgical methods,45 cases in each group.The treat-ment,pain,SF-36 score and other indicators of two groups were observed.Results The rate of excellence and good was 97.78% in the study group and 86.67% in the control group,the difference was significant(P<0.05).The blood loss was (46.83 ± 3.64)mL in the study group and (79.32 ±5.47)mL in the control group,the difference was significant(P<0.05).There was no significant difference in the scores of SF-36 and JOA between the two groups(P>0.05).After treatment,the two groups were significantly improved(P<0.05),the improvement rate of the study group was more obvious (P<0.05).After treatment,TNF-α,IL-6 and CRP levels were significantly better than those in the control group (P<0.05).Conclusion Percutaneous intervertebral foramen treatment of extreme lateral lumbar disc herniation can reduce the intraoperative blood loss and improve the quality of life
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Objective To compare and analyze the clinical effects of different local anesthetics on continuous epidural anesthesia for percutaneous enucleation of nucleus pulposus. Methods A total of 40 patients underwent lumbar intervertebral discoscopy (PTED) from November 2015 to November 2016, according to the choice of anesthesia is divided into group A and group B, 20 cases in each group. Group A used 0.5％lidocaine local anesthesia, group B treated with continuous epidural anesthesia (1 ％ lidocaine 3 mL+0.5％ ropivacaine).Analysis of two groups before operation, the curative effect, VAS score, modified Bromage score, intraoperative pain perception includes four criteria, namely, mild, moderate and severe, the former two satisfactory anesthetic effect; the latter two are not satisfied with the anesthesia. Results Two cases without postoperative cerebrospinal fluid leakage occurred, nerve root injury and other complications; two groups of patients with pain satisfaction difference was statistically significant (P<0.05); compared with group A, the levels of HR and MAP in group B were more stable (P<0.05). Conclusion Continuous epidural anesthesia is more suitable for PTED than local anesthesia. It can reduce the pain and the occurrence of cardiovascular and cerebrovascular accidents in patients, and does not affect the patients' lower limb movement score.
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Objective To observe the effect of extracorporeal shock wave (ESW) combined with intervertebral foramen injection on the lumbar facet joint syndrome.Methods Ninety-three patients presenting the syndrome were randomly divided into acombined group,ashock wave group and acontrol group,each of 31,according to a random number tab.All three groups were given a nonsteroidal anti-inflammatory drug,the shock wave group was additionally treated with a course of ESW,while the combined group received the shock wave treatment and lumbar intervertebral foramen injection.The three groups were assessed using theOswestry disability index (ODI),theRoland Morris Disability Questionnaire (RMDQ)and a life quality scale (QOL-SF36) beforetreatment and after 1,4 and 8 weeks of treatment.Pain was reported using a visual analogue scale (VAS).Results Theaverage VAS,ODI,RMDQ and QOL-SF36 scores of the three groups had all improved after the treatment.After one week the average scores of VAS (2.6±1.4),ODI (15.9±8.3),RMDQ (9.9±5.4) and QOL-SF36 (74.6±17.1) of the combined group had improved significantly more than those of the control group [VAS (4.3± 1.3),ODI(22.8± 6.9),RMDQ (14.9±7.7) and QOL-SF36 (61.6±17.7)].Fourweeks after the treatment,the averageVAS,ODl,RMDQ andQOL-SF36 scores [(2.5±1.3),(15.1±7.3),(9.8±5.1) and (76.8±16.8)] of the shock wave group had improved significantly more than those of the control group [(3.9 ± 1.4),(20.3 ± 8.2),(13.9 ± 8.1) and (67.2±20.6)].Such significant improvements lasted until 8 weeks after the treatment.ConclusionsESW combined with intervertebral foramen injection can relieve the pain oflumbar facet joint syndrome,improve lumbar vertebral function and patients' quality of life.It is worthy of clinical application.
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Objective To evaluate the efficacy of percutaneous endoscopic BEIS technique in the treatment of recurrent lumbar disc herniation and to analyze its possible prognostic factors.Methods A total of 39 patients who are diagnosed as lumbar disc herniation and treated with percutaneous endoscopic BEIS technique were selected from March 2013 to March 2015.The clinical efficacy was evaluated according to VAS,ODI,JOA and modified MacNab criteria in the follow-up,and the possible prognostic factors were analyzed.Results The average follow-up time was 14 months(12 ～ 18 months).According to the MacNab standard,the excellent and good rate was 82.1％.The average score of back and leg pain VSA was reduced from(7.33 ± 1.01)before operation to(2.69 ± 1.50)after operation,t =16.111,the difference was statistically significant (P ＜ 0.05);ODI and JOA were used to evaluate lumbar function,the score of ODI was reduced from (59.08 ± 7.16) to (13.54 ± 3.36),t =35.946,and that of JOA was increased from(14.92 ±3.37) to(26.05 ± 1.76),t =-18.526,the difference was statistically significant (P ＜ 0.05).Patients with symptoms lasting no more than 3 months and with no lateral recess stenosis were able to obtain good therapeutic effect.Conclusion This study indicates that percutaneous endoscopic BEIS technique is effective in the treatment of recurrent lumbar disc herniation,and duration of symptoms and lateral recess stenosis are important prognostic factors.
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Objective To explore the operative indications and efficacy of intervertebral foramen puncture combined with internal fixa -tion via paraspinal approach in the treatment of lumbosacral tuberculosis .Methods A total of 69 patients who treated with intervertebral fo-ramen puncture combined with internal fixation via paraspinal approach in spinal surgery department of Daping hospital affiliated to army medical university from January 2010 to January 2017 were retrospectively analyzed .All patients had preoperative standardized oral isoniazid , rifampicin,pyrazinamide,ethambutol for 2 to 4 weeks.The surgical methods included intervertebral foramen puncture ,drainage of paraverte-bral abscess and posterior paraspinal muscle gap approach fixation .The surgery time,intraoperative blood loss ,postoperation drainage ,abscess absorption,healing of lesions and Oswestry scores were recorded and observed .Results The operation time was from 130 to 220 minutes, with average of 140 minutes;the blood loss was from 50 to 150 mL,with average of 110 mL;the total volume of drainage was 30 to 180 mL, with average of 70 mL.All patients were followed up for 12 to 21 months.All cases were recovered except 1 patient who suffered from sacral tuberculosis received debridement and suturing caused by cutaneous necrosis .There was no infection , injury of spinal cord and nerve nor looseness or shift of internal fixation .The abscess was completely absorbed after 12 months.The Oswestry scores before surgery was (68.15 ± 18.36),while it was(11.64 ±8.12) at final followed-up,the difference was significant(P<0.05).Conclusion The surgical treatment of intervertebral foramen puncture combined with internal fixation via paraspinal approach is effective for patients who suffered large paraverte -bral abscess, parts of vertebral body collapse with segmental instability and mild kyphosis of spine with spinal cord disfunction ,which is a safe and effective surgical method .
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STUDY DESIGN: Prospective study based on magnetic resonance (MR) imaging of the lumbar spinal root of the intervertebral foramen. PURPOSE: This study was to compare MR three-dimensional (3D) sequences for the evaluation of the lumbar spinal root of the intervertebral foramen. OVERVIEW OF LITERATURE: The diagnosis of spinal disorders by MR imaging is commonly performed using two-dimensional T1- and T2-weighted images, whereas 3D MR images can be used for acquiring further detailed data using thin slices with multi-planar reconstruction. METHODS: On twenty healthy volunteers, we investigated the contrast-to-noise ratio (CNR) of the lumbar spinal root of the intervertebral foramen with a 3D balanced sequence. The sequences used were the fast imaging employing steady state acquisition and the coherent oscillatory state acquisition for the manipulation of image contrast (COSMIC). COSMIC can be used with or without fat suppression (FS). We compared these sequence to determine the optimized visualization sequence for the lumbar spinal root of the intervertebral foramen. RESULTS: For the CNR between the nerve root and the peripheral tissue, these were no significant differences between the sequences at the entry of foramen. There was a significant difference and the highest CNR was seen with COSMIC-FS for the intra- and extra-foramen. CONCLUSIONS: In this study, the findings suggest that the COSMIC-FS sequences should be used for the internal or external foramen for spinal root disorders.
Subject(s)
Diagnosis , Healthy Volunteers , Magnetic Resonance Imaging , Prospective Studies , Spinal Nerve RootsABSTRACT
Objective To evaluate the application of high-resolution ultrasonography in the diagnosis of nerve root lesion of cervical vertebra intervertebral foramen part. Methods Twenty-seven patients with root avulsion injury of brachial plexus intervertebral part and 8 patients with schwannoma of brachial plexus root were examined with high-resolution ultrasonography. Thirty healthy volunteers were involved for the sonographic imagings of normal brachial plexus intervertebral part. The ultrasound findings of the patients before operation were compared with surgical outcomes. Results The normal intervertebral part of brachial plexus were shown as hypoechoic tubular strucuture, which could be identified with cervical artery and transverse process used as landmarks for the intervertebral part of brachial plexus root. The detection ratios of normal intervertebral part for C5-C8 and outside part of braehial plexus were 100％. In 27 patients with root avulsion injury of intervertebral brachial plexus, the intervertebral nerve root were enlarged as hypoechoic area, with nerve dissected partly or disappearing, distal nerve parts outside the intervertebral foramen swelling, edema,or cerebrospinal fluid assembling as cystic masses. In 8 patients with schwannoma of brachial plexus root part, the spinal ganglia outside intervertebral foramen were shown as tumor-like hypoechoic mass, with blood supply shown inside. Conclusions High-resolution ultrasonography is of great value for early and convenient diagnosis of root avulsion injury and mass of brachial plexus intervertebral part, especially in community hospitals,which could provide important information for clinical therapy.
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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.
Subject(s)
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.
Subject(s)
Aged , Female , Humans , Male , Anesthetics, Local , Brachial Plexus , Cricoid Cartilage , Epidural Space , Needles , Shoulder , Skin , Spinal Cord , Upper ExtremityABSTRACT
[Objective]To explore the clinical effect of cervical spondylotic radiculopathy treated with intervertebral foramen block and brachial plexus traction-like technique.[Methods]54 cases of cervical spondylotic radiculopathy were randomly divided into two groups,i.e.control group(cervical traction and brachial plexus traction-like technique) and treatment group(added with intervertebral foramen block).[Results]The cure rate and effective rate were 66.67% and 92.59% in treatment group,and 25.93% and 78.78% in control group,respectively.Clincal efficacy is significantly better in treatment group than that in control one(P
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Objective To examine the morphological changes in the cervical intervertebral foramen during axial rotation of cervical spine and explore its clinical significance for the diagnosis and treatment of cervical degenerative disease. Methods Ten healthy volunteers (5 male, 5 female) were subjected to transectional scan by multislice spiral computed tomography of cervical spine from the upper edge of C 3 vertebra to the lower edge of C 7 vertebra. On the 45 degree oblique reconstructions of C 3～4, C 4～5, C 5～6 and C 6～7 intervertebral foramina, four parameters were measured, including foraminal height, foraminal width (both superior and inferior), and cross-sectional area of the foramen. Statistic analyses were performed to examine the morphological changes in the cervical intervertebral foramen. Results It was found that the foraminal cross-sectional area was decreased on the side of rotation,and increased on the opposite side of rotation. Significant correlation was revealed between the variation rate of the C 3～4 intervertebral foramen cross-sectional area and the rotational degree between C 3 and C 4. Conclusion Morphologic changes were found in the cervical intervertebral foramen due to axial rotation. The correlation between the cross-sectional foraminal areas with the degrees of rotation of the vertebrae was statistically significant. The results of the test have the clinical significance on the prevention, diagnosis and treatment of the cervical degenerative diseases, especially of the radiculopathy.
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In this study, we measured the intervertebral foramina on the plain radiographs of cervical spine of fifty three patients who were over forty-year-old, and with single or multiple unilateral cervical radiculopathies on EMG. In order to determine if the foraminal stenosis on plain radiographs can determine the presense of radiculopathy, four parameters such as vertical diameter, mid-transverse diameter, inferior transverse diameter, and area were measured by a digital caliberator(CD-15C, Mitutoyo, Japan) and an image analyzer(VIDAS 2.0, Kontron, Germany) in 194 foramina of both sides(affected and unaffected groups). Another 80 foramina were also measured as control group in ten age-matched patients who did not show any abnormality on EMG. In control group, C4/5 intervertebral foramen showed maximal values of the parameters among foramina, with vertical diameter of 10.55+/-0.35 mm(mean+/-S.D.), mid-transverse diameter of 6.22+/-0.33 mm, inferior transverse diameter of 5.09+/-0.19 mm and area of 0.77+/-0.05 cm2. The minimal values were noted in C6/7 foramen except those of the vertical diameter which were noted in C4/5 foramen. The mid-transverse diameter and area of C7/T1 intervertebral foramen of affected group were significantly smaller than those of control and unaffected groups(p<0.05). The other values in affected group were also smaller among the groups but they did not reach statistical significance. In conclusion, the mid-transverse diameter and area of intervertebral foramen on plain cervical radiographs are somewhat useful to determine the encroachment of nerve root within the intervertebral foramen, especially in the lower cervical spine, in patients with cervical radiculopathy.
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Humans , Constriction, Pathologic , Radiculopathy , SpineABSTRACT
One of the most common mechanisms of failure of epidural anesthesia is the misplacement of a catheter. We present two cases of transforaminal escape of catheter which occurred accidentally during lumbar epidural anesthesia. Epidural catheter was inserted to a depth of 4.5 cm and 3.5 cm respectively, then 2% lidocaine 25 ml were injected slowly into the catheter. No analgesia was found except anterior knee area, so Iohexol dye was injected through the catheter for X-ray determination. The epidurogram showed the catheter, which passed through the intervertebral foramen, was to lie outside the epidural space in the paravertebral tissue. Because of the random direction and migration of epidural catheter, we suggest an epidural catheter should be inserted 3cm into the epidural space. Epidurogram with a small dose of contrast material is advisable in the cases of unsatisfactory effect of epidural block, or when some adverse reactions are noted after block.