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Objective:To anatomically study the external bone graft axis from the pedicle (canal) to the endplate designed for compression healing fractures of the anterior vertebral column in freshly dried vertebral specimens from T10 to L5.Methods:Eight groups of freshly dried vertebral specimens from T10 to L5 (128 vertebral bodies and 256 lateral pedicles and lateral vertebral bodies) were used to observe the vertebral axis of the pedicle (canal), the internal sagittal diameter of the pedicle (canal), and the sagittal diameter of the vertebral body, and the position of vertebral pedicle (canal) axis (f-angle) before design of the external bone graft axis from the pedicle (canal) to the endplate of the compression healing vertebral body. (1) The internal sagittal diameter of the pedicle (canal) was divided into 3 segments. The lateral segment of the vertebral plate was wide, the middle segment of the isthmus of the vertebral arch was narrow and the medial segment of the terminal segment of the vertebral arch was wide. The narrow isthmus of the middle arch (canal) was used as a transposition axis in the design of the axis of the bone graft from the vertebral arch (canal) to the endplate of the compression healing vertebral body. (2) The axis of the vertebral body of the pedicle (canal) was located medial to the transposition axis, parallel to the f-angle at 0° as described by Saillant G. (3) The compression degree of the vertebral body was measured at the outer edge of the lateral anterior column, with Ⅰ° for less than 1/4 compression of the anterior column of the vertebral body, Ⅱ° for 1/4 to 2/4, Ⅲ° for 2/4 to 3/4 and Ⅳ° for more than 3/4 of the compression. (4) The f-angle described by Salliant G at the entry end which was corresponding to the endplate of the compression healing vertebral body was used to design the pedicle (canal) to the outer implant axis of the endplate of the compression healing vertebral body.Results:At an f-angle of 8° to 10°, the bone graft axis was aligned with the Ⅱ° compression healing vertebral endplate on the superior endplate side of the vertebral body axis of the arch; at an f-angle of 16° to 18°, the bone graft axis corresponded to the superior endplate of the Ⅰ° compression healing vertebral body. At an f-angle of -10°~-8°, the bone graft axis corresponded to the Ⅲ° compression healing vertebral endplate on the inferior endplate side of the vertebral body axis of the arch; at an f-angle of -18°~-16°, the bone graft axis corresponded to the inferior endplate of the Ⅳ° compression healing vertebral body.Conclusions:The external axis from the pedicle (canal) to the endplate designed in the present anatomic study for compression healing fractures of the anterior vertebral column allows for safe and easy granular bone implantation due to the toughness of the cortical bone around the arch root (canal) in addition to the precise design of the bone graft axis from the pedicle to the endplate from T10 to L5.
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Objective:To evaluate the accuracy of an ultrasound-guided robot-assisted system for percutaneous facet joint puncture in an animal experiment by registration of ultrasound images and two-dimensional X-ray fluorescence images.Methods:Six specimens of fresh adult sheep lumbar spine were prepared and soaked in gelatin solution. The specimens contained a total of 48 facet joints with 24 ones respectively on the left and right sides. Half of the joints were assigned by the random number table method into a robot-assisted group which were subjected to percutaneous facet joint puncture assisted by the ultrasound-guided robot-assisted system while the contralateral ones into a freehand group which were subjected to percutaneous facet joint puncture by freehand. In the robot-assisted group, the left facet joints were 3 L 1, 3 L 2, 3 L 3 and 3 L 4 ones while the right facet joints were 2 L 1, 3 L 2, 5 L 3 and 2 L 4 ones. In this self-control animal experiment, both the robot-assisted punctures and the freehand punctures were carried out in the same specimen. The puncture success rate, puncture needle adjustment, positioning deviation, orientation deviation and operation time were recorded. Results:The positioning deviation and orientation deviation in the robot-assisted group [(2.21 ± 1.12) mm and 1.51° ± 0.47°] were significantly lower than those in the freehand group [(3.26 ± 1.44) mm and 2.24° ± 0.89°] ( P < 0.05). All the articular facet joint punctures were successfully accomplished for the first time in the robot-assisted group while those required multiple adjustments in the freehand group. In the robot-assisted group, the total operation time [(463.84 ± 34.93) s] was significantly longer than that in the freehand group [(298.40 ± 27.48) s], but the puncture time [(37.97 ± 6.87) s] was significantly shorter than that in the freehand group [(261.61 ± 33.15) s] ( P < 0.05). Conclusion:The ultrasound-guided robot-assisted system for percutaneous facet joint puncture can lead to accurate puncture with limited needle adjustments.
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Objective:To explore the feasibility and clinical efficacy of oblique lateral interbody fusion (OLIF) in the treatment of adjacent segment disease (ASDis).Methods:Retrospective analysis was conducted on the data of 31 patients with ASDis treated by OLIF in four medical centers from June 2015 to December 2018. There were 17 males and 14 females. The average age was (65.7±3.4) years (range, 59 to 75 years). 19 cases received single-segment fixed fusion, 11 cases received double-segment fixed fusion and 1 case received three-segment fixed fusion. Original fixed fusion site: 1 case of L 1, 2, 3 cases of L 3, 4, 11 cases of L 4, 5, 4 cases of L 5S 1, 6 cases of L 3-L 5, 5 cases of L 4-S 1, and 1 case of L 3-S 1. The time from the initial fixation and fusion to this admission was 82.5±45.5 months (rang, 24 to 180 months). ASDis occurred at the proximal end of the fixed fusion segment in 28 cases and at the distal end in 3 cases. The types of ASDis: degenerative disc disease in 11 cases, lumbar spinal stenosis in 15 cases, degenerative spondylolisthesis in 2 cases, and degenerative scoliosis in 3 cases. The location of ASDis: 6 cases of L 2, 3, 12 cases of L 3, 4, 6 cases of L 4, 5, 3 cases of L 1-L 3, 1 case of L 2-L 4, and 3 cases of L 1-L 4. At admission, 3 cases of lumbar internal fixation had been removed and 28 cases of internal fixation remained. Stand-alone OLIF was performed in 19 cases, OLIF combined with pedicle screw fixation in 8 cases, and OLIF combined with cortical screw fixation in 4 cases. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the low back pain and lumbar function before operation and at the last follow-up, and the imaging results and complications were observed. Results:All patients were followed up. The follow-up time was 23.6±9.6 months (range, 12 to 60 months). The operation time was 73.8±25.3 mins (range, 40 to 180 min), and the intraoperative blood loss was 86.2±67.4 ml (range, 20 to 310 ml). The average blood loss in each segment was 24.8 ml. During the operation, there were 1 case of segmental vein injury, 7 cases of endplate injury, 2 cases of transient iliopsoas muscle weakness, 1 case of thigh pain and numbness, and 1 case of incomplete intestinal obstruction. There was no incision necrosis and infection. The VAS score of low back pain decreased from 5.9±1.9 before operation to 1.4±0.6 at the last follow-up, with a statistically significant difference ( t=8.47, P<0.001). The ODI index recovered from 45.2%±5.7% before operation to 13.8%±4.7% at the last follow-up, with a statistically significant difference ( t=7.92, P<0.001). The height of intervertebral space increased from 8.7±1.6 mm before operation to 11.4±1.9 mm after operation and 9.9±1.8 mm at the last follow-up. There was a statistically significant difference between postoperative and preoperative height of intervertebral space ( F=4.15, P=0.007). There was a statistically significant difference between the last follow-up and postoperative height of intervertebral space ( P=0.011). During the follow-up, there were 13 cases of fusion cage subsidence, 1 case of fusion cage displacement, and no case of internal fixation loosening or fracture. The intervertebral fusion rate was 94%(29/31) and the complication rate was 42%(13/31). Conclusion:ASDis is a common complication after lumbar fixation and fusion, and requires surgical treatment. OLIF is a reliable method to treat ASDis as it has advantages of small trauma, high fusion rate and low complication rate.
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OBJETIVO: Iliopsoas e o músculodiafragma compartilham fixação comum nas vértebras L2, a contração do iliopsoas pode levar à redução da excursão do diafragma levando à dificuldade respiratória. Portanto, o presente estudo controlado fornecerá evidências sobre o efeito da liberação do músculo iliopsoas na melhoria da eficiência respiratória em pacientes com dor lombar crônica. MÉTODO / DESENHO: Um total de trinta e quatro participantes com lombalgia crônica mecânica lombar crônica devido à rigidez dos flexores do quadril, dor lombar crônica e dificuldade respiratória serão recrutados com base nos critérios de seleção e serão alocados aleatoriamente em dois grupos, Grupo A (tratamento conservador + liberação miofascial iliopsoas), Grupo B (tratamento conservador + tratamento simulado). Ambos os grupos receberão a intervenção três vezes por semana durante 3 semanas. As medidas de resultado serão o Questionário de Incapacidade de Roland Morris, a Escala Numérica de Avaliação da Dor e a Capacidade de Difusão do Pulmão, pois o monóxido de carbono será usado como medidas de resultado. DISCUSSÃO: Este estudo ajudará a identificar a eficácia da liberação de iliopsoas na dor lombar e seu efeito nos parâmetros respiratórios. REGISTRO DO ENSAIO: Este ensaio foi registrado prospectivamente em cliniclatrials.gov (CTRI / 2020/04/024661), em 16 de abril de 2020.
BACKGROUND AND PURPOSE: Iliopsoas and diaphragm muscle share common attachment at L2 vertebrae, iliopsoas tightness may lead to reduce diaphragm excursion leading to breathing difficulty. Therefore, the present controlled trial will provide evidence on the effect of the iliopsoas muscle release in upgrading respiratory efficiency in patients with chronic low back pain. METHOD/DESIGN: A total of thirty-four participants with mechanical chronic low back pain due to hip flexor tightness and having breathing difficulty will be recruited based on selection criteria. It will be randomly allocated into Group A (conservative treatment + iliopsoas myofascial release), Group B (conservative treatment + sham treatment). Both the group will receive the intervention three times a week for three weeks. The outcome measures will be the Roland Morris Disability Questionnaire, Numeric Pain Rating Scale, and diffuse capacity of Lung for Carbon monoxide as outcome measures. DISCUSSION: This trial will help identify the effectiveness of iliopsoas release in low back pain and its effect on respiratory parameters. TRIAL REGISTRATION: This trial has been prospectively registered at cliniclatrials.gov (CTRI/2020/04/024661) on 16 April 2020.
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Low Back Pain , Diaphragm , Carbon MonoxideABSTRACT
BACKGROUND: Even pedicle screw fixation system is commonly used in spinal surgery, elderly patients with high bone fragility lack of bone elasticity, insufficient holding power of pedicle screw. Thus, there is a risk of loosening and pulling out the screws, leading to failure of spine reduction and fixation. Thus, we need to explore new method to increase the stability of the pedicle screw system. OBJECTIVE: To explore the long-term effect of pedicle screw internal fixation with bone cement in the treatment of different types of lumbar degenerative diseases with osteoporosis. METHODS: Sixty patients suffering from degenerative spinal disease with the complication of osteoporosis were randomly assigned to control group and trial group (n=30 per group). Before adopting the treatment of bone cement pedicle screw fixation and fusion, all patients had taken pre-operation examination, X-ray, CT and MRI scan. The patients in the control group were treated with conventional pedicle screw technology, and those in the experimental group were treated with bone cement on the basis of the conventional pedicle screw technology. Visual analogue scale score and Oswestry disability index were compared between the two groups 1 day before surgery, 1 week, 6 months, and 1 year after surgery. Complications were observed after surgery to evaluate the effect of the operation. RESULTS AND CONCLUSION: (1) At 1 week, 6 months and 1 year after surgery, the visual analogue scale score and Oswestry disability index were significantly better than those of pre-operation (P < 0.05). Visual analogue scale score and Oswestry disability index were significantly lower at 6 months and 1 year after surgery than those 1 week after surgery (P < 0.05). Visual analogue scale score and Oswestry disability index were significantly lower at 1 year than those at 6 months after surgery (P < 0.05). (2) Visual analogue scale score and Oswestry disability index were better in the trial group than those in the control group at 6 months and 1 year after surgery (P < 0.05). (3) The incidence of internal fixation rod loosening was lower in the trial group than that in the control group. (4) It is concluded that bone cement pedicle screw fixation and fusion in the treatment of degenerative spinal disease with osteoporosis can effectively improve the clinical symptoms and reduce the occurrence of complications. It is safe and effective in clinical application, and the long-term treatment effect is acceptable.
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Sacrum is centrally located unpaired bone of pelvis which is composed of 5 sacral vertebrae. Superiorly itarticulates with 5th lumbar vertebra to form lumbosacral joint and laterally it articulates with hip bone to formsacroiliac joint. When 5th lumbar vertebra fuses with 1st sacral vertebra then it is called as sacralization andwhen 1st sacral vertebra gets separated from sacrum then it is called as lumbarization. 79sacra from thedepartment of Anatomy of MGM medical college and D. Y. Patil medical college, Navi Mumbai were studied to seesacralization. Out of 79 sacra in 14sacra(17.7 %) sacralization was observed.Out of 14 sacra, 4 sacra showedbilateral and complete sacralization, 5 sacra showed unilateral and partial sacralization and 5 sacrashowedincomplete fusion between L5 and S1 vertebra. Change in normal structure of lumbar vertebra andsacrum may lead to alteration in kinematics of lumbosacral region which may lead to compression of nerve andlow back pain. Knowledge regarding incidence of sacralization will be useful for radiologist and orthopaedicsurgeon while dealing with low back pain
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Objective The morphological data of the second thoracic vertebra and the third lumbar vertebra were measured by computerized tomography （CT）. The sex differences were analyzed and the discrimination equation was obtained. Methods The data of 274 adults （203 cases from experimental group and 69 cases from validation group） from central China were collected. Four linear data （maximum transverse length of vertebral body, maximum longitudinal length of vertebral body, maximum transverse length of vertebral foramen, maximum longitudinal length of vertebral foramen）, one angle data （angle between spinous processes） and two area （vertebral foramen area, total cross-sectional area of vertebral body） data of the second thoracic vertebra and the third lumbar vertebra were collected, respectively. Then three ratios ［maximum transverse length/ maximum longitudinal length of vertebral body, maximum transverse length/ maximum longitudinal length of vertebral foramen, vertebral foramen area/ （total cross-sectional area of vertebral body-vertebral foramen area）］ and one angle （angle between spinous processes） were obtained. The discriminant equation was established for sexual discriminant analysis. Results The morphology of the second thoracic vertebra and the third lumbar vertebra was related with gender. Four single index discriminant formulae and eleven multi-index discriminant formulae were established. The 69 validation group samples were substituted into the formula for testing, and the maximum discriminant accuracy rate of the single-index discriminant formula was 75%. The maximum discriminant accuracy rate of multi-index discriminant formula was 83%. Conclusion It is feasible to conduct individual sex analysis by the morphological indexes of second thoracic vertebra and the third lumbar vertebra. The indexes have important application values in practice.
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Female , Male , China , Lumbar Vertebrae/diagnostic imaging , Thoracic Vertebrae/diagnostic imaging , Tomography, X-Ray Computed , Vertebral BodyABSTRACT
Objective: To observe the accuracy and repeatability of Revolution CT energy spectrum imaging for measuring bone mineral density (BMD) of lumbar vertebra phantom. Methods: Revolution CT was used with different tube current and different tube rotation speed combinations, a total of 20 sets of scanning conditions, and the European spine phantom (ESP) were scanned repeatedly for 10 times. The Hydroxyapatite (HAP) value of L1, L2, and L3 vertebral bodies were measured by energy spectral material decomposition technique, and the measured HAP values were compared with actual values. At the same time, the volume CT dose index (CTDIvol) of each scanning condition were recorded and compared. Then the repeatability of measurements with CT machines was observed. Results: Under 20 groups of conditions, the measured HAP values of L1, L2 and L3 intervertebral bodies were statistically significant (all P0.05), and CTDIvol was 9.09 mG and 15.46 mGy, respectively. Conclusion: Revolution CT scan is accurate in measuring BMD of ESP, especially with tube rotation speed 0.8 s/rot and tube current 230 mA, and the radiation dose is low. The repeatability between different CT machines of same model is good.
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BACKGROUND: The non-fusion system of lumbar interspinous process distraction device provides a new treatment option for lumbar degenerative diseases. However, at present, the clinical application and research of lumbar interspinous process distraction device are reported insufficiently in China, especially for the domestic lumbar interspinous process distraction device. OBJECTIVE: To verify the scientific nature and effectiveness of the new domestic lumbar interspinous process distraction device through finite element analysis and in vitro biomechanical experiment of goat lumbar spine. METHODS: (1) Finite element analysis of new domestic lumbar interspinous process distraction device: L2-L5 three-dimensional model of vertebral body was established based on normal adult lumbar CT data. From then on, new domestic lumbar interspinous process distraction device model, new lumbar interspinous process distraction device model of lumbar non fusion system were successively built. The mechanical conditions were given under the physiological conditions of lumbar spine. Biomechanical analysis was carried out before and after the new domestic lumbar interspinous process distraction device was implanted. (2) In vitro biomechanical analysis of new domestic lumbar interspinous process distraction device: the lumbar vertebrae (L1-L5) of 24 adult male goats were obtained, and the new domestic lumbar interspinous process distraction device was implanted between the L3-4 spinous process. Before and after the placement of the lumbar interspinous process distraction device, the lumbar motion range and the pressure of the intervertebral disc under the flexion, extension, lateral bending and rotation of the lumbar specimens were detected. RESULTS AND CONCLUSION: (1) After the new lumbar interspinous process distraction device was implanted, the motion range and the pressure of the intervertebral disc of responsible segment were reduced, while the adjacent segments' mobility and the pressure of the intervertebral disc were almost unaffected. It was theoretically verified that the new domestic lumbar interspinous process distraction device could provide the biomechanical basis for the treatment of the lumbar degenerative diseases, and contribute to the theoretical reference for the prevention of the clinical diseases. (2) In the state of extension, the motion range of L3-4 vertebral body after implanting the new lumbar interspinous process distraction device was significantly lower than that before implantation (P 0. 05). In the state of flexion, lateral bending and rotation, there was no significant difference between L2-3, L3-4 and L4-5 vertebral body after implanting the lumbar interspinous process distraction device and that before implantation (P > 0. 05). In the state of extension, the pressure of intervertebral disc after L3-4 vertebral body implantation was significantly lower than that before implantation (P 0. 05). In the state of flexion, lateral bending and rotation, there was no significant difference between L2-3, L3-4 and L4-5 vertebral body implantation and that before implantation (P > 0. 05). (3) The results showed that the scientific nature and validity of the new domestic lumbar interspinous process distraction device was verified by three-dimensional finite element analysis and in vitro animal lumbar specimens experiment, which provided a strong basis for the animal experiment, clinical experiment, clinical application and clinical production of the new domestic lumbar interspinous process distraction device.
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BACKGROUND: Lumbar spinal stenosis is one of the key causes of gait disorder and low back pain in the older adults. Hypertrophy of the ligamentum flavum is the main pathological mechanism leading to lumbar spinal stenosis. Although there are numerous imaging and pathological studies on the ligamentum flavum, little is reported on cell apoptosis. OBJECTIVE: To detect the apoptotic rate and the expression of caspase-3, fas and p53 in the hypertrophic ligamentum flavum, providing experimental evidence for understanding the mechanism underlying degeneration of the ligamentum flavum. METHODS: In experimental group, 50 hypertrophic ligamentum flavum specimens (L2-S1) confirmed by MRI and postoperative measurement were obtained from 50 patients with lumbar spinal stenosis who underwent posterior decompression surgery. There were 22 males and 28 females, aged from 32 to 74 years old, with an average of 54.46 years old. In control group, 30 non-hypertrophic ligamentum flavum specimens (L2-S1) confirmed by MRI and postoperative measurement were obtained from 30 patients with lumbar disc herniation undergoing surgery and lumbar burst fractures. There were 19 males and 11 females, aged 19-67 years, with an average of 47.27 years old. The apoptotic rate in the ligamentum flavum was detected by TUNEL staining, and the expression of caspase-3, fas and p53 was detected by SP immunohistochemistry. The study protocol was approved by the Ethics Committee of the Sixth Affiliated Hospital of Xinjiang Medical University, with approval No. LFYLLSJ2016007. RESULTS AND CONCLUSION: TUNEL results showed that the average apoptotic rate of the experimental group was (37.80±3.04)%, which was significantly higher than that of the control group [(13.18±1.34)%; t=41.83, P < 0.001]. The immunohistochemical staining of SP revealed that the positive expression percentages of caspase-3, fas and p53 in the ligamentum flavum were all 100% in the experimental group, while the positive percentages were 13.3%, 16.7%, and 10% in the control group, respectively. There was a significant difference between the two groups (P < 0.001). These findings indicate that cell apoptosis in the hypertrophic ligamentum flavum is increased and has a certain correlation with the up-regulation of caspase-3, fas and p53.
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BACKGROUND: In recent years, the finite element analysis of lumbar biomechanics has become a hot topic. Lumbar lordosis is considered to reduce the pressure load on the lumbar intervertebral disc and protect the lumbar spine. OBJECTIVE: To study the biomechanical effects of lumbar traction on L1-L5 lumbar segments in normal physiological curvature, flexion position and maximum overextension position, and to evaluate the optimal physiological curvature of lumbar traction. METHODS: A healthy male volunteer, aged 26 years, with a height of 174 cm and a weight of 60 kg, was selected, who had no history of lumbar spine diseases. With the L3 segment as the traction site, a finite element model of the whole lumbar spine was established based on lateral radiographs of the lumbar spine at the initiation site and during the maximal overextension as photographed by a DR machine. Based on the three-dimensional finite element model of the lumbar spine, the stress values and distributions of the lumbar vertebrae, the intervertebral joints, the intervertebral discs and the anterior longitudinal ligaments of the whole lumbar spine under different physiological curvatures were calculated. The patient was fully informed of the study protocol and signed an informed consent. The study protocol was approved by the Ethics Committee of Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine. RESULTS AND CONCLUSION: (1) Under six kinds of simulated working conditions, the range of motion of L1-L2 was 9.31° for flexion and extension, 9.84° for right and left bending, and 4.43° for right and left rotation; the range of motion of L2-L3 was 10.22° for flexion and extension, 12.35° for left and right bending, and 4.57° for left and right rotation; the range of motion of L3-L4 was 11.20° for flexion and extension, 11.63° for left and right bending, and 5.32° for left and right rotation; the range of motion of L4-L5 was 13.16° for flexion and extension, 11.58° for left and right bending, and 5.05° for left and right rotation. Under the normal physiological curvature of the lumbar vertebrae, the stress value of different lumbar spine structures was much greater than the stress value of hyperextension traction. The normal curvature of the anterior longitudinal ligament was 2.47 MPa, and the curvature of hyperextension traction value was 21.20 MPa. The stress value of L3 was the highest, which was four times that of the hyperextension traction. The stress value of the intervertebral joints at L2-L3 and intervertebral disc was highest than that of any other segment of the lumbar spine. These findings indicate that the pressure of lumbar vertebrae, intervertebral joints and intervertebral discs in hyperextension position is less than that in normal physiological curvature traction, and the pressure of anterior longitudinal ligament is always within the safe range. Lumbar traction may have better clinical efficacy and definite security in hyperextension position.
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Objective: To explore the feasibility of bone mineral density (BMD) of T12 for replacing abnormal L1 or L2 for diagnosis of osteoporosis during lung cancer screening with low-dose CT and bone mineral density examination with quantitative CT. Methods: Totally 1 298 healthy individuals who underwent lung cancer screening with low-dose CT and BMD examination with quantitative CT were enrolled. BMD of T12 to L2 vertebrae were measured, and the calibrated BMD of T12 was calculated and recorded as T12*. Taking L1+L2 as diagnostic criteria, the consistencies in bone mass assessment and the differences in diagnosis of osteoporosis among vertebral combinations of T12+L1, T12+L2, T12*+L1, T12*+L2 and L1+L2 were analyzed, respectively. Results: There were good consistencies between vertebral combinations and L1+L2 in bone mass assessment (all Kappa>0.75, all P98%. The sensitivities of T12+L1 and T12+L2 in osteoporosis diagnosis were 73.33% (143/195) and 77.95% (152/195), respectively, whereas of T12*+L1 and T12*+L2 in osteoporosis diagnosis were 83.08% (162/195) and 90.26% (176/195), respectively. Conclusion: BMD of T12 for replacing abnormal L1 or L2 during quantitative CT can reduce the sensitivity in diagnosis of osteoporosis, therefore BMD of T12 should be calibrated in measurement.
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Extreme lateral interbody fusion (XLIF) can be used to treat various lumbar diseases, such as lumbar facet joints intervertebral disc herniation, spondylolisthesis, stenosis. Compared with other approaches, XLIF establishes the surgical channel behind the peritoneum through lateral abdomen, with the advantages of less blooding in the surgery, smaller invasion, lower complications rate and shorter rehabilitation period. Meanwhile，this technique can not only reduce the risk of vascular injury, but also avoid the damage of back structures，such as muscles and facet joints. Therefore, XLIF has been attracting more and more attention and application. However, there is no conclusive evidence to prove that XLIF is better than other surgical approaches in terms of clinical results and complications rates. This paper reviewed the effects of XLIF for reconstructing spinal stability, as well as its biomechanical properties compared with other classical surgeries.
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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
Introduction: It has been suggested that reduced inter-pedicular distance is one of the cause of primary narrowingof the spinal canal may lead to low back pain.Transpedicular approaches are being widely used in many surgeriessuch as bone biopsy, bone grafting, Pedicle screw fixation, vertebroplasty and kyphoplasty. The morphometricdata of lumbar vertebra from Udaipur district i.e. in southern Rajasthan is to the best of our knowledge, virtuallyunexplored so we under took this study.Aims and objectives: The present study aims at determining the morphometric norms of Pedicle of the lumbarvertebra in Udaipur zone measured in dried bone. In this study the following measurements on Pedicle of lumbarvertebra are taken i.e. pedicle height, pedicle width and Interpedicular distance.Materials and methods: The present study was done on the 110 dry adult human lumbar vertebrae from variousmedical colleges of Udaipur. The morphometrical data of the Pedicle of human lumbar vertebrae were measuredand analysed. Digital vernier calliper was used to measure the morphometric data.Result and discussion: The pedicle height of Pedicle decreased from L1 to L5 except in L2 and width of Pedicleincreased from L1 to L5. Interpedicular distanced gradually increased from L1 to L5.
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There are total of five lumbar verteae. Out of five, four lumbar verteae show typical features. The fifth lumbar vertea shows certain atypical features. Lumbar verteae are identified as having massive kidney–shaped bodies, superior and inferior articular facets, pedicles and thick and quadrangular spine. We observed a malformed lumbar vertea in college bone bank during routine Osteology tutorials.
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OBJECTIVE: To compare the spinal enumeration methods that establish the first lumbar vertebra in patients with spinal variants. MATERIALS AND METHODS: Of the 1446 consecutive patients who had undergone computed tomography of the spine from March 2012 to July 2016, 100 patients (62 men, 38 women; mean age, 47.9 years; age range, 19–88 years) with spinal variants were included. Two radiologists (readers 1 and 2) established the first lumbar vertebra through morphologic analysis of the thoracolumbar junction, and labeled the vertebra by counting in a cranial-to-caudal manner. Inter-observer agreement was established. Additionally, reader 1 detected the 20th vertebra under the assumption that there are 12 thoracic vertebra, and then classified it as a thoracic vertebra, lumbar vertebra, or thoracolumbar transitional vertebra (TLTV), on the basis of morphologic analysis. RESULTS: The first lumbar vertebra, as established by morphologic analysis, was labeled by each reader as the 21st segment in 65.0% of the patients, as the 20th segment in 31.0%, and as the 19th segment in 4.0%. Inter-observer agreement between the two readers in determining the first lumbar vertebra, based on morphologic analysis, was nearly perfect (κ value: 1.00). The 20th vertebra was morphologically classified as a TLTV in 60.0% of the patients, as the first lumbar segment in 31.0%, as the second lumbar segment in 4.0%, and as a thoracic segment in 5.0%. CONCLUSION: The establishment of the first lumbar vertebra using morphologic characteristics of the thoracolumbar junction in patients with spinal variants was consistent with the morphologic traits of vertebral segmentation.
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Female , Humans , Male , Anatomic Variation , SpineABSTRACT
Lumbar interbody fusion is one of the most commonly used surgical treatment of lumbar disease at present, but the hidden blood loss after surgery is large, accounting for 1/3 or even more than 1/2 of total blood loss. If not monitored and treated for the hidden blood, it can result in anemia and prolong bed time, thereby increasing the chance of infection. This paper summarizes the mechanism, influencing factors, calculation and treatment of hidden blood loss after lumbar fusion, so that the surgeon can have a correct understanding and evaluation of the hidden blood loss for the patients undergoing lumbar intervertebral fusion, and so as to reduce the occurrence of complications. This is very important for helping patients to pass perioperative period smoothly.
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Humans , Lumbar Vertebrae , Lumbosacral Region , Occult Blood , Perioperative Period , Retrospective Studies , Spinal Fusion , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To discuss the advantages and disadvantages of two different surgical approaches combined fixation with lumbar interbody fusion in treating single segmental lumbar vertebra diseases.</p><p><b>METHODS</b>The clinical data of 86 patients with single segmental lumbar vertebra diseases treated from June 2011 to June 2013 was retrospectively analyzed. There were 33 males and 53 females, aged from 28 to 76 years old with an average of 53.0 years. Among them, there were 39 cases of lumbar disc degeneration, 22 cases of lumbar disc herniation complicated with spinal canal stenosis, 9 cases of huge lumbar disc herniation and 16 cases of lumbar degenerative spondylolisthesis (Meyerding degree I ). Lesion sites contained L3, 4 in 5 cases, L4, 5 in 70 cases and L5S1 in 11 cases. All the patients were treated with internal fixation and lumbar interbody fusion with 45 cases by midline incision approach (median incision group) and the other 41 cases by channel-assisted by muscle-splitting approach(channel group). Incision length, operation time, intraoperative bleeding and postoperative drainage were recorded in two groups. Visual analogue scale(VAS) was used to assess lumbar incision pain 72 h after operation. Depended on imaging results to compare the changes of the disc space height in lesion in preoperative, postoperative and final follow-up, the coronal and sagittal Cobb angle in preoperative and final follow-up, the area of multifidus and the degree of multifidus fat deposition before and after operation between two groups. Loosening or fragmentation of internal fixation, displacement of intervertebral cage and interbody fusion were observed in each group. Japanese Orthopedic Association (JOA) scoring system was used to evaluate the function before operation and at the final follow-up.</p><p><b>RESULTS</b>The channel group was superior to the median incision group in incision length and postoperative drainage while the median incision group was less than the channel group in the operation time and intraoperative bleeding. The average VAS score of lumbar incision 72 h after operation was 1.50 points in median incision group and 0.97 points in channel group, and there was significant difference between two groups(<0.05). No incision infection was found, but there were 4 cases of incisional epidermal necrosis, 1 case of incision healed badness, and 3 cases of nerve injury in channel group. The incidence of cacothesis of pedicle screw were 5.0% and 3.6% in median incision group and channel group respectively, and there was no significant difference between two groups(>0.05). The incidence of cacothesis of translaminar facet screw were 6.6% and 12.2% in median incision group and channel group respectively, and there was significant difference between two groups(<0.05). All the patients were followed up for 12 to 36 months with a mean of 22.8 months. The changes of disc space height had statistical difference between preoperative and postoperative(<0.05) in all patients, but there was no significant difference between postoperative and final follow-up(>0.05), however, there was no significant difference 3 days after operation and final follow-up between two groups(>0.05). At final follow-up, coronal and sagittal Cobb angle were obviously improved in all patients(<0.05), but there was no significant difference between two groups(>0.05). One year after operation, the area of multifidus in median incision group was (789.00±143.15) mm² less than preoperative(1 066.00±173.55) mm² (<0.05), and in channel group, was(992.00±156.75) mm² at 1 year after operation and(1 063.00±172.13) mm² preoperatively, there was no significant difference between them(>0.05), however, there was significant difference one year after operation between two groups (<0.05) . About the degree of multifidus fat deposition, there was significant difference between one year after operation and preoperation in median incision group (<0.05), but there was no significant difference between one year after operation and preoperation in channel group (>0.05), and there was significant difference at one year after operation between two groups(<0.05). During the follow-up period, neither pedicle screw and/or translaminar facet screw loosening, displacement or fragmentation nor displacement of intervertebral cage were found. The lumbar interbody fusion rate was 95.6% in median incision group and was 95.1% in channel group, and there was no significant difference between two groups(>0.05). No obvious adjacent segmental degeneration was observed in fixed position. JOA score in median incision group was significantly increased from 8-16 points (average: 12.77±2.56) preoperative to 21-29 points (average: 25.20±2.43) at final follow-up(<0.05); and in channel group was significantly increased from 8-16 points (average: 12.64±2.37) preoperative to 23-29 points(average: 26.7±1.82) at final follow-up(<0.05); there was also significant difference between two groups at final follow-up.</p><p><b>CONCLUSIONS</b>Compared to the median incision approach, unilateral pedicle screw combined with contralateral translaminar facet screw fixation using channel-assisted by muscle-splitting approach has advantages of small incision, less trauma, fast recovery and so on. However, it also has shortages such as high surgical complications incidence, especially in cases that.</p>
ABSTRACT
<p><b>OBJECTIVE</b>To discuss the characteristics of lumbar disc herniation (LDH) with symptom aggravated caused by spinal manipulative therapy (SMT).</p><p><b>METHODS</b>Detailed clinical profiles of a total number of 10 LDH patients with symptoms aggravated after SMT were reviewed including 5 males and 5 females with age from 46 to 68 years old, 7 patients of them were more than 50 years old. The clinical data of 10 patients were analyzed involving age, gender, clinical symptoms, signs, imaging findings, surgical treatment and prognosis. Laminectomy and discectomy were performed, and follow-up was carried out in all patients.</p><p><b>RESULTS</b>The duration of symptoms in all the patients before SMT was 4 to 15 years. After the therapy, an acute exacerbation of back and radicular pain was observed within 24 hours. MRI showed intervertebral disc herniation, 7 patients were observed in L4-L5. The time internal between the exacerbation of presentation and surgery was 23.1 days. No perioperative complications occurred. All the patients were relieved of radicular pain a few days after surgery. During postoperative follow-up, all patients regained the ability to walk; Eight patients reported a complete resolution of presentation and the rest two patients were significantly improved.</p><p><b>CONCLUSIONS</b>SMT should be prohibited in some LDH patients to prevent neurological damages, in whom there are 5 possible risk factors.</p>