Evaluation of the applicability of musculoskeletal ultrasonography of the thoracolumbar and lumbar spine segment of healthy dogs / Avaliação da aplicabilidade da ultrassonografia musculoesquelética do segmento toracolombar e lombar da coluna vertebral de cães hígidos

Changes in the spine of dogs are usually detected in clinical and in surgical practice. Few studies exist on musculoskeletal ultrasound anatomy of the thoracolumbar and lumbar segments of the normal spine of dogs. This study aimed to compare the normal musculoskeletal ultrasound anatomy of the T10-S1 vertebral segments with images obtained with magnetic resonance imaging (MRI), computed tomography (CT), and anatomical structures, and to establish the ability to identify structures using these modalities. Ultrasound scans allowed visualization of the muscles of the region, articular processes, spinous process, interspinous ligament, and yellow ligament in the lumbosacral window. Computed tomography images provided better bone details, compared to ultrasound images. Low-field MRI allowed the identification of the same structures identified with ultrasound imaging, and allowed the identification of cerebrospinal fluid, transverse processes, and provided improved detail of the intervertebral discs and spinal cord. Knowledge of ultrasound anatomy of the region may allow the the identification of muscle and ligament injuries. Thus, in cities where CT and MRI are inaccessible, ultrasonography of the region could be a good alternative to identify possible changes not observable with radiographic examination or to complement radiographic examination.(AU)

Alterações na coluna vertebral de cães são comumente encontradas na rotina clínica e cirúrgica veterinária. Existem poucos estudos sobre a anatomia ultrassonográfica musculoesquelética do segmento toracolombar e lombar da coluna vertebral normal de cães. O objetivo deste trabalho foi comparar a anatomia ultrassonográfica musculoesquelética normal dos segmentos vertebrais T10-S1 com imagens obtidas pela ressonância magnética, tomografia computadorizada e peças anatômicas visando demonstrar a sua capacidade de identificação de estruturas. A varredura ultrassonográfica permitiu a visibilização da musculatura da região, processos articulares, processos espinhosos, ligamentos interespinhosos e ligamento amarelo na janela lombossacra. A tomografia computadorizada forneceu imagens com melhor detalhamento ósseo quando comparada ao exame ultrassonográfico. A ressonância magnética de baixo campo permitiu a identificação das mesmas estruturas que o exame ultrassonográfico acrescido da identificação do líquido cerebroespinal, processos transversos e melhor detalhamento dos discos intervertebrais e medula espinhal. Com o conhecimento da anatomia ultrassonográfica da região, acredita-se que lesões musculares e ligamentares possam ser identificadas. Vale salientar que em cidades onde a tomografia computadorizada e a ressonância magnética não estejam acessíveis a ultrassonografia da região pode ser uma boa alternativa para identificar possíveis alterações não visibilizadas ao exame radiográfico, ou complementá-lo.(AU)

Hipoplasia vertebral asociada a cifosis toracolumbar en lactantes: ¿variante anatómica? casos clínicos / Lumbar hypoplasia associated to thoracolumbar kyphosis in infants: anatomic variant? clinical cases

INTRODUCCIÓN: La hipoplasia vertebral es una anomalía de los cuerpos vertebrales, en la que estos tienen forma de cuña, habitualmente a nivel de la unión toracolumbar. Si bien se asocia a ciertas enfermedades de depósito y displasias óseas, es posible encontrar una hipoplasia vertebral aislada en lactantes sanos, o en presencia de cifosis toracolumbar. El objetivo del presente manuscrito es dar a conocer la evolución de la hipoplasia vertebral asociada a cifosis en dos lactantes aparentemente sanos. CASOS CLÍNICOS: Se presentan dos casos de lactantes en que se pesquisó cifosis lumbar clínicamente visible durante la sedestación. Las radiografías de columna de ambos mostraron hipoplasia vertebral lumbar a nivel de L2 como único hallazgo en la morfología vertebral. Luego de descartar causas asociadas, se indicó manejo conservador: en el primer caso, en que la cifosis era de 18° se indicó seguimiento clínico-radiológico; mientras que, en el segundo caso, que tenía una angulación de 57° en sedestación, se indicó tratamiento con corsé. La evolución en ambos fue favorable, con re solución clínica radiológica a la edad de 15 meses en el primer caso y en el segundo caso, a los 3 años y 4 meses se constató regresión clínica de la cifosis con persistencia de una imagen de leve hipoplasia vertebral. CONCLUSIONES: La hipoplasia vertebral aislada o asociada a cifosis puede considerarse una anomalía menor o bien una variante anatómica del desarrollo de la columna del lactante, no obstan te, requiere seguimiento hasta su normalización.

INTRODUCTION: Vertebral hypoplasia is an anomaly of the vertebral bodies, in which they present a wedge shape, usually at the level of the thoracolumbar junction. Although it is associated with cer tain storage diseases and bone dysplasias, it is also possible to find isolated vertebral hypoplasia it in healthy infants or associated with thoracolumbar kyphosis. The objective of this report is to show the evolution of vertebral hypoplasia associated to kyphosis in two apparently health children. CASE REPORT: Two cases of infants diagnosed with clinically visible lumbar kyphosis when they were sitting. Spine X-rays of both showed lumbar vertebral hypoplasia at L2 level as the only finding. After ruling out other conditions associated with vertebral hypoplasia, conservative management was indicated; in the first case a clinical-radiological follow-up and in the second one, a corset given the magnitude of kyphosis. The evolution was favorable, with complete radiological clinical resolution at the age of 15 months in the first case and clinical regression in the second, in which, at 3 years and 4 months of age, an image of mild vertebral hypoplasia persisted. CONCLUSIONS: Isolated vertebral hypoplasia or associated to kyphosis may be considered a minor anomaly or anatomic variant of infant spine development, however, it requires follow-up until its normalization.

Lumbarisation of the first sacral vertebra a rare form of lumbosacral transitional vertebra / Lumbarización de la primera vertebra sacra: rara forma de una vertebra de transición lumbosacral

In the lumbosacral region, anatomical variations occur with changes in the number of sacral vertebra either by deletion of first sacral vertebra or by the union of fifth lumbar or first coccygeal vertebra with sacrum. Lumbasacral transitional vertebrae (LSTV) is the most common congenital anomalies of the lumbosacral region. It most commonly involves the fifth lumbar vertebra showing signs of fusion to the sacrum known as sacralisation or the first sacral vertebra shows signs of transition to a lumbar configuration commonly known as lumbarisation. Complete transition can result in numerical abnormalities of the lumbar and sacral vertebral segments. Lumbarisation of first sacral vertebra is seen with a very low incidence of 2%. Knowledge of presence of such vertebral variation will be helpful for the clinicians to diagnose and treat patients with low back pain. Although sacralisation of fifth lumbar vertebrae is most commonly seen when compared to lumbarisation of first sacral vertebrae, we report here a case of lumbarisation of first sacral vertebrae for its rarity among the LSTV and clinical implications.

En la región lumbosacra, las variaciones anatómicas se basan en cambios en el número de las vértebras sacras, ya sea por ausencia de la primera vértebra sacra o por unión de la quinta lumbar o primera vértebra caudal con el sacro. Las vértebras de transición lumbasacra (VTLS) son las anomalías congénitas más frecuentes de la región lumbosacra. La VTLS más común se produce a nivel de la quinta vértebra lumbar, con signos de fusión al sacro, proceso conocido como sacralización; mientras que la primera vértebra sacra también puede mostrar signos de transición a una configuración lumbar. A esto último se lo denomina lumbarización. La transición completa puede provocar anomalías numéricas a nivel de los segmentos vertebrales lumbares y sacros. La lumbarización de la primera vértebra sacra se observa con una incidencia muy baja, de solo 2%. El conocimiento de la presencia de dicha variación vertebral será de utilidad para los médicos al momento de diagnosticar y tratar a los pacientes con dolor en la parte baja de la espalda. Aunque la sacralización de la quinta vértebra lumbar se produce más frecuentemente en comparación con la lumbarización de la primera vértebra sacra, se presenta aquí un caso de lumbarización de la primera vértebra sacra, rara entre las VTLS, y con implicaciones clínicas.

Diagnóstico ecográfico prenatal de sirenomelia: a propósito de un caso / Prenatal ultrasound diagnosis of Sirenomelia: about a case

RESUMEN La sirenomelia constituye una anomalía congénita rara. Su incidencia es de 1:60.000 nacidos vivos. Es causada por un defecto vascular disruptivo y caracterizado por la fusión de las extremidades inferiores, asociados a anomalías cardiacas, renales, de pared abdominal y torácica, vértebras inferiores, tubo digestivo inferiores, genitales y de las arterias umbilicales. Se presenta la experiencia de un caso de sirenomelia que se ha podido diagnosticar con la ecografia prenatal.

ABSTRACT Sirenomelia is a very rare congenic anomaly. Being its incidence of approximately 1:60.000 live born, caused by a vascular disruptive defect, characterized by the fusion of lower limbs, associated to cardiac, renal, abdominal wall, and thoracic anomalies; also characterized by inferior vertebrae, inferior digestive tract, genital and umbilical artery anomalies A case of sirenomelia has been diagnosed thanks to prenatal echography.

Differentiating between Traumatic Pathology and Congenital Variant: A Case Report of Butterfly Vertebra

Butterfly vertebra is a rare congenital malformation of the spine, which is usually reported in the literature as an isolated finding. We describe a 40-year-old woman that presented to our emergency department with back pain and sciatica. Initial radiological evaluation revealed an incidental finding of a L4 butterfly vertebra in the anteroposterior and lateral view radiographs. The patient presented with no neurological deficit. This rare congenital anomaly is usually asymptomatic, and awareness of its non-traumatic nature is critical in order to establish a correct diagnosis. Further evaluation of the patient is necessary to exclude pathologic fracture, infection, or associated vertebral anomalies and syndromes, such as Alagille, Jarcho-Levin, Crouzon, and Pfeiffer syndromes. Furthermore, in the emergency setting, awareness of this entity is needed so that a correct diagnosis can be established.

Lumbosacral Fixation Using the Diagonal S2 Screw for Long Fusion in Degenerative Lumbar Deformity: Technical Note Involving 13 Cases

Placing instrumentation into the ilium has been shown to increase the biomechanical stability and the fusion rates, but it has some disadvantages. The diagonal S2 screw technique is an attractive surgical procedure for degenerative lumbar deformity. Between 2008 and 2010, we carried out long fusion across the lumbosacral junction in 13 patients with a degenerative lumbar deformity using the diagonal S2 screws. In 12 of these 13 patients, the lumbosacral fusion was graded as solid fusion with obvious bridging bone (92%). One patient had a rod dislodge at one S2 screw and breakage of one S1 screw and underwent revision nine months postoperatively. So, we present alternative method of lumbopelvic fixation for long fusion in degenerative lumbar deformity using diagonal S2 screw instead of iliac screw.

Lumbosacral transitional vertebrae: a case report and clinical implications / Vértebras lumbosacras de transición: reporte de un caso e implicancias clínicas

A lumbosacral transitional vertebra is a rare congenital anomaly which occurs because of defect in the segmentation of the lumbosacral spine during development. During routine osteology classes for the medical students at the Kasturba Medical College, Mangalore, India, one of the sacra showed the fusion of the fifth lumbar vertebra with the sacrum. The specimen showed an incomplete fusion (sacralization) on the left side and the transverse process was of the large butterfly shape, while on the right it was about the usual size. Though this variation is well known, the details of this anomaly are rarely reported in the anatomical literature. Since there is a strong relationship between the lumbosacral transitional vertebrae and low back pain, this anomaly has gotten increased clinical interest. So this case was studied in detail with relevant review of literature and its surgical, radiological implications are discussed.

Una vértebra de transición lumbosacra es una anomalía congénita rara que se produce debido a defectos en la segmentación de la columna lumbosacra durante el desarrollo. Durante una clase de osteología para estudiantes de medicina en Kasturba Medical College, Mangalore, India, una de las regiones sacras mostró fusión de la quinta vértebra lumbar con el sacro. El especimen mostró fusión incompleta (sacralización) en el lado izquierdo y el proceso transverso tenía forma de mariposa grande, mientras que en el derecho se observó de tamaño normal. A pesar que esta variación es conocida, los detalles de esta anomalía rara vez son reportados en la literatura anatómica. Puesto que existe una fuerte relación entre las vértebras de transición lumbosacra y el dolor de espalda baja, esta anomalía tiene gran interés clínico. Este caso fue estudiado en detalle con la revisión pertinente de la literatura, y son discutidas sus implicancias quirúrgicas y radiológicas.

Validation, repeatability and reproducibility of a noninvasive instrument for measuring thoracic and lumbar curvature of the spine in the sagittal plane / Validade, repetibilidade e reprodutibilidade de um instrumento não-invasivo para medição das curvaturas torácica e lombar da coluna vertebral no plano sagital

BACKGROUND: The need for early identification of postural abnormalities without exposing patients to constant radiation has stimulated the development of instruments aiming to measure the spinal curvatures. OBJECTIVE: To verify the validity, repeatability and reproducibility of angular measures of sagittal curvatures of the spine obtained using an adapted arcometer, by comparing them with Cobb angles of the respective curvatures obtained by using X-rays. METHODS: 52 participants were submitted to two procedures designed to evaluate the thoracic and lumbar curvatures: (1) X-ray examination from which the Cobb angles (CA) of both curvatures were obtained, and (2) measuring the angles with the arcometer (AA). Two evaluators collected the data using the arcometer, with the rods placed at T1, T12, L1 and L5 spinous processes levels in a way as to permit linear measurements which, with aid of trigonometry, supplied the AA. RESULTS: There was a very strong and significant correlation between AA and CA (r=0.94; p<0.01), with no-significant difference (p=0.32), for the thoracic curvature. There was a strong and significant correlation for the lumbar curvature (r=0.71; p<0.01) between AA and CA, with no-significant difference (p=0.30). There is a very strong correlation between intra-evaluator and inter-evaluator AA. CONCLUSION: It was possible to quantify reliably the thoracic and lumbar curvatures with the arcometer and it can thus be considered valid and reliable and for use in evaluating spinal curvatures in the sagittal plane.

CONTEXTUALIZAÇÃO: A necessidade de identificação precoce de alterações posturais, sem expor as pessoas à radiação constante, tem estimulado a construção de instrumentos para medir as curvaturas da coluna vertebral. OBJETIVO: Verificar a validade, repetibilidade e reprodutibilidade dos ângulos das curvaturas sagitais da coluna vertebral, obtidos por meio de um arcômetro adaptado, comparando-os com os ângulos de Cobb (AC) das respectivas curvaturas, obtidos por meio de exames radiográficos. MÉTODOS: Cinquenta e dois indivíduos foram submetidos a dois procedimentos destinados a avaliar as curvaturas torácica e lombar: (1) exame de raios-X, a partir do qual os AC de ambas as curvaturas foram obtidos e (2) medição dos ângulos das curvaturas com o arcômetro (AA). Dois avaliadores coletaram os dados usando o arcômetro com as hastes sobre os processos espinhosos T1, T12, L1 e L5, de modo a permitir medidas que, com auxílio de trigonometria, forneceram os AA. RESULTADOS: Encontrou-se correlação muito forte e significativa entre AA e AC (r=0,94, p<0,01), sem diferença significativa (p=0,32) para a curvatura torácica, enquanto, para a curvatura lombar, encontrou-se uma forte e significativa correlação (r=0,71, p<0,01) entre AA e AC, sem diferença significativa (p=0,30). Existe uma correlação muito forte intra-avaliador e inter-avaliador nos AA. CONCLUSÃO: O arcômetro permitiu quantificar as curvaturas torácica e lombar, podendo-se considerar as medições válidas, fidedignas e objetivas para uso na avaliação de curvaturas da coluna vertebral no plano sagital.

[Evaluation of maternal diabetes effects on lumbosacral portion of spinal cord in neonate rats by morphometry]

The aim of this investigation was to evaluate effects of maternal diabetes on lumbosacral region of spinal cord in offspring of diabetic mothers [ODM] in comparison with normal mothers. In this study sixteen adult female rats were divided in two groups. Diabetes was induced in one group by Alloxan [145 mg/kg]. Both groups became pregnant by natural matting. After delivery lumbosacral samples were prepared from 7 day, 14 day, 21 day and 28 day old offspring of both groups. After applying histological techniques, various histological parameters were determined. Weight of infants was measured at the same time and compared with the other group. Data were analyzed by student t-test. Our results showed that the weight of ODM were significantly [21.2%] more than the control group [P<0.05]. There is a significant decrease in transverse and vertical diameters of spinal cord and decrease in number of neurons in grays matter of spinal cord of ODM compared to the control group [P<0.05]. Hyperglycaemia caused by maternal diabetes can disturb natural formation of spinal cord, especially in the lumbosacral region. This defect leads to different malformations, such as change in the shape of spinal cord and also decrease in the number of neurons in grays mater. These problems are formed in fetal period and remain in the body after birth and lead to offspring disability in several actions

Transitional lumbosacral vertebrae and low back pain: diagnostic pitfalls and management of Bertolotti's syndrome / Dor lombar associada à vértebra de transição lombossacra: dificuldades no diagnóstico e manejo da síndrome de Bertolotti

OBJECTIVE: Bertolotti's syndrome is a spine disorder characterized by the occurrence of a congenital lumbar transverse mega-apophysis in a transitional vertebral body that usually articulates with the sacrum or the iliac bone. It has been considered a possible cause of low back pain. METHOD: We analyzed the cases of Bertolotti's syndrome that failed clinical treatment and reviewed the literature concerning this subject. RESULTS: Five patients in our series had severe low back pain due to the neo-articulation and two of them were successfully submitted to surgical resection of the transverse mega-apophysis. Taking into account the clinical and surgical experience acquired with these cases, we propose a diagnostic-therapeutic algorithm. CONCLUSION: There is still no consensus about the most appropriate therapy for Bertolotti's syndrome. In patients in whom the mega-apophysis itself may be the source of back pain, surgical resection may be a safe and effective procedure.

OBJETIVO: A síndrome de Bertolotti é uma desordem congênita da coluna vertebral caracterizada pela ocorrência de uma mega-apófise transversa lombar em uma vértebra de aspecto transicional, que geralmente se articula com o sacro ou com o osso ilíaco. Tal síndrome tem sido considerada possível causa de dor lombar. MÉTODO: Análise dos casos de síndrome de Bertolotti que apresentavam dor lombar sem melhora com tratamento conservador e revisão dos artigos publicados. RESULTADOS: Foram revisados cinco pacientes que não apresentaram melhora com o tratamento clínico, sendo que dois foram submetidos à ressecção cirúrgica da mega-apófise transversa. Considerando a experiência adquirida com estes casos, os autores propõem um algoritmo para diagnóstico e tratamento da Síndrome de Bertolotti. CONCLUSÃO: Ainda não há consenso sobre qual é a terapia mais apropriada para a Síndrome de Bertolotti. Em pacientes em que a mega-apófise parece ser a origem da lombalgia, a ressecção cirúrgica parece ser um procedimento seguro e efetivo.

Relationship between electrodiagnostics, MRI findings and clinical picture in lumbar canal stenosis

To study the relationship between the electrodiagnostic and the MRI findings of the lumbar spine and to correlate them to the clinical features in patients with degenerative lumbar spinal stenosis [LSS]. Fifty-six patients diagnosed as having LSS, on the basis of typical clinical features and compatible MRI findings, were included in this study. In addition to history and examination, patients were assessed for disease severity using the maximal walking distance and the visual analogue scale. MRI parameters of lumbar spinal stenosis were assessed. Needle electromyography of the paraspinal muscles and nerve conduction studies including F-wave and H-reflex were performed. Patients were 33 males and 23 females. The body mass index statistically significantly correlated with the patient scores on the visual analogue scale. No significant relation could be detected between age, sex, duration of disease and disease severity. Both of the smallest and the smallest two anteroposterior spinal canal diameters showed no statistical significant correlation with the disease severity. The fibrillations in electromyographic testing statistically highly significantly [p<0.001] negatively correlated with the maximal walking distance and positively correlated with the patient scores on the visual analogue scale. It also statistically highly significantly correlated with the age. MRI findings are related to the diagnosis but not to severity ot the clinical lumbar spinal stenosis. Electrophysiologic studies especially paraspinal muscles denervation potentials seem to be a more sensitive criterion in assessing the severity of symptoms in patients with LSS

Manejo quirúrgico del síndrome de Bertolotti: a propósito de un caso / Surgical management of the Bertolotti´s syndrome: case report

We present the case of a 31 year-old man with a story of chronic low back pain in the presence of a transitional lumbosacral vertebra with transverse mega apophysis articulating with the sacrum (Bertolotti´s syndrome). After unsuccessful conservative treatment, an anesthetic blockade in the transverse process and sacral ala joint was performed with complete but brief relief of pain. For that reason, a resection of the transverse process was performed. There is no agreement in the relationship between back pain and the presence of a mega-apophysis. Therefore, surgical treatment of this condition is even more controversial. In the absence of other pain generators, the known biomechanical dysfunction of lumbosacral transitional vertebra in conjunction with a positive injection test lead us to consider surgical resection of the mega-apophysis as an alternative treatment in refractory low back pain. The proven biomechanical alteration of lumbosacral transitional junction and the systematic searching of sources of pain through anesthetic blocks allows that in cases of refractory pain surgical treatment of the mega-apophysis can be an effective alternative.

Presentamos el caso de un paciente varón de 31 años con historia de dolor lumbar crónico mecánico portador de una anomalía de transición lumbosacra con mega-apófisis transversa articulada al ala sacra. El paciente luego de varios tratamientos médicos fallidos fue sometido a bloqueo anestésico de la pseudo articulación transverso sacra con alivio completo pero pasajero de su dolor. Finalmente, se realiza una resección de la mega apófisis con buenos resultados a corto y largo plazo. La relación entre dolor lumbar y la presencia de una mega-apófisis es controvertido. De igual forma el tratamiento quirúrgico consistente en resección de la mega-apófisis es más controvertido aún. La probada alteración biomecánica del segmento lumbosacro transicional junto al descarte sistemático de otras fuentes de dolor y la confirmación diagnóstica mediante bloqueos anestésicos permite plantear que en casos de dolor refractario a tratamiento conservador la resección de la mega-apófisis puede ser una alternativa eficaz.

Síndrome de regresión caudal: caso clínico extremo y revisión de la literatura / Caudal regression syndrome: a severe case report and review of literature

Caudal regression syndrome (SRC) is a disruption of development of distal spinal segments, which affects in most cases, the development of lumbar vertebrae and sacrum. The exact etiology is still unknown; however, it has been related to pre and maternal diabetes, genetics factors and diminished vascular supply. At this time, we present an extreme case of SRC; 4 months old boy, his mother is diabetic, poorly controled, who presents SRC with spinal cord to T2.

El síndrome de regresión caudal (SRC), es una alteración del desarrollo de los segmentos espinales distales, que afecta en la mayoría de los casos el desarrollo del sacro y vértebras lumbares. La etiología exacta aun no esta precisada, sin embargo, se ha relacionado con la diabetes previa y gestacional, factores genéticos y la hipoperfusión vascular. En esta ocasión, se presenta el caso de regresión caudal extrema de un paciente masculino, de 4 meses de edad a la fecha, hijo de madre diabética, mal controlada en embarazo, que presenta SRC con presencia de médula espinal hasta T2.

Morfometría de los pedículos vertebrales: un exhautivo estudio anatómico en la región lumbar / Morphometry of vertebral pedicles: a comprehensive anatomical study in the lumbar region

This comprehensive anatomical study on bones and X-rays regarding pedicles of lumbar vertebrae was performed in two parts. In the first part of the present work direct gross measurements of 3 different diameters (v, d, and 1) of both the pedicles of LI to L5 vertebrae (200 male and 200 female) were recorded through sliding vernier caliper. In the second part plain anteroposterior radiographs of the lumbar spine from 500 individuals (250 males and 250 females) were collected, and divided in 6 age groups and 2 different diameters (t and h) were recorded. The minimum horizontal diameter (d) of both the pedicles increased from LI to L5. Whereas, the vertical height (v) of both the pedicles increased from LI to L2, decreased from L2 to L3 and increased from L3 to L5. The anteroposterior length (1) increased bilaterally from LI to L2 and decreased from L2 to L5. All the aforementioned parameters were greater in male than corresponding vertebrae of female. Same trends were confirmed by the radiological study. The maximum horizontal diameter (t) of pedicles on both sides of vertebrae was significantly greater in females in less than 20 years of subjects, due to early pubertal growth spurt, whereas it was significantly greater in males in rest of all the age groups at all segments of vertebral spine. The maximum vertical height (h) of both the pedicles was significantly greater in males of age groups greater than 30 years from LI to L5.

Este estudio sobre huesos y radiografías del pedículo de las vértebras lumbares fue realizado en dos partes. En la primera se midieron directamente con un caliper, 3 parámetros (v, d, y 1) en los pedículos de Ll a L5 (200 casos de sexo femenino y 200 de sexo masculino). En la segunda parte, se recolectaron 500 radiografías anteroposteriores (250 de hombres y 250 de mujeres) y se dividieron en 6 grupos etarios, registrándose dos diferentes diámetros (t y h). El diámetro horizontal menor se incrementó de Ll a L5 mientras que la altura vertical (v) de ambos pedículos de Ll a L2, decreció de L2 a L3 y se incrementó de L3 a L5. La longitud anteroposterior (1) se incrementó bilateralmente de Ll a L2 y decreció de L2 a L5. Todos los parámetros mencionados fueron mayores en el hombre que en la mujer. Los mismos se confirmaron en el estudio radiográfico. El diámetro horizontal máximo (t) de los pedículos de ambos lados fue significativamente mayor en mujeres con menos de 20 años debido a un temprano crecimiento acelerado en la pubertad mientras que, fue significativamente mayor en los hombres en todos los grupos etarios, en la totalidad de las vértebras. La altura vertical máxima de ambos pedículos fue significativamente mayor en los hombres del grupo mayor de 30 años desde Ll a L5.

Correlation between clinical features and magnetic resonance imaging findings in patients with lumbar disc herniation

To find out the correlation of clinical features and magnetic resonance imaging [MRI] findings in determining the level of lumbar disc herniation. It was an analytic study, which was conducted in the department of Neurosurgery, Pakistan Institute of Medical Sciences [PIMS], Islamabad, from 1st May 2002 to 1st March 2003. The total number of patients with prolapsed intervertebral disc, selected for this study was fifty. The clinical level of disc herniation was determined and was correlated with MRI findings. For data analysis, SPSS 10 soft ware was used. In 29 [58%] patients there was right sciatica, while eighteen [36%] had bilateral sciatica. Straight leg raising test was positive in 47 [94%] patients. On MRI, 48 [96%] cases had prolapsed intervertebral discs [PIVD] at L4-L5 and L5-S1 levels and 2 [4%] patients had L3-4 disc herniation. Thirty-eight patients had posterolateral disc herniation and 12 patients had central disc herniation. At L4-L5 level, the sensitivity, specificity, positive predictive value and negative predictive value of all clinical features was 92%, 96%, 95.85 and 88.46% respectively. The chi square value for L4-L5 and L5-S1 was 38.78 [P=0.000] and 22.12 [P=0.000] respectively, while for multiple level disc herniation, it was 3.42 [P=0.064]. Majority of PIVD lie in lower lumbar region. There is excellent correlation between the clinical features and MRI findings in the diagnosis of single level disc herniation but no correlation occurs in case of multiple level disc herniations

Síndrome de duplicación caudal / Caudal duplication syndrome

El síndrome de duplicación caudal comprende un espectro de alteraciones congénitas raras, con una patogenia probablemente multifactorial, en el cual estructuras derivadas de la cloaca embrionaria y de la notocorda están duplicadas en extensiones variables. Presentamos una paciente con duplicación completa de la columna vertebral lumbosacra desde L3, que además tiene lipomeningocele, duplicación vesicouretral, anorrectal y vaginal. Se describen los hallazgos imagenológicos y se realizan una revisión bibliográfica

Lumbar spinal stenosis: Evaluation of surgical Results in 100 cases

Although lumbur spinal stenosis syndrome is extremely common, considerable controversy continues to surround its classification, diagnosis and treatment. The aim of this study is evaluation of results of surgical therapy for lumbar spinal stenosis in 100 patients. In this article, we retrospectively analyzed the clinical, radiologicaLand surgical results of 100 patients operated in our neurosurgical clinics with the diagnosis of lumbar spinal stenosis. Surgical therapy and outcome are discussed with respect to the known facts. After clinical and radiological evaluation, 100 patients were diagnosed with lumbar spinal stenosis. All patients underwent laminectomy and bilateral foraminotomy at the stenotic level. Surgical outcomes were evaluated as very good, good,same, and poor according to the clinical findings. Fifty- three of the patients were males and forty-seven were females.More than half were between the ages of 40 and 60.The most frequently operated level was L4-L5. Ninety two percent of the surgically treated patients demonstrated very good and good outcomes. Our conclusion in lumbar spinal stenosis diagnosed by objective clinical and radiological findings is that decompressive laminectomy and extensive foraminotomy without instrumentation allow a good outcome

Exámen médico laboral del raquis lumbosacro / Lumbar spine: laboral X-Ray examination

El presente trabajo tiene por objeto repasar conceptos relacionados con el exámen radiológico del raquis lumbosacro desde el punto de vista laboral y a la luz de la legislación vigente en la actualidad (Ley de riesgo de trabajo N§ 24557, capítulo III artículo 6). También hace hincapié en la responsabilidad que le cabe al especialista en diagnóstico por imágenes en todo lo referente a la detección de patología osteoarticular presente en el momento del exámen y/o condiciones anatómicas que favorezcan la aparición de patología en un futuro. Se hace además un repaso de las mediciones más frecuentes a tener en cuenta a la hora generar el informe radiológico como así también la necesidad de recurrir, cuando las circunstancias lo requieran, a exámenes de mayor complejidad. Se efectúa un repaso de la embriología de la columna como generadora de patología con implicancia laboral y de la anatomía y fisiología del raquis