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Purpose: Screwed anterior lumbar interbody fusion (SALIF) alleviates the need for supplemental posterior fixation leading to reduction of perioperative morbidity. Specifically, elderly and multimorbid patients would benefit from shorter operative time and faster recovery but tend to have low bone mineral density (BMD). The current study aimed to compare loosening, defined as increase of ROM and NZ, of SALIF versus transforaminal lumbar interbody fusion (TLIF) under cyclic loading in cadaveric spines with reduced BMD. Methods: Twelve human spines (L4–S2; 6 male 6 female donors; age 70.6 ± 19.6; trabecular BMD of L5 84.2 ± 24.4 mgHA/cm3, range 51–119 mgHA/cm3) were assigned to two groups. SALIF or TLIF were instrumented at L5/S1. Range of motion (ROM) and neutral zone (NZ) were assessed before and after axial cyclic loading (0–1150 N, 2000 cycles, 0.5 Hz) in flexion–extension (Flex–Ext), lateral bending, (LB), axial rotation (AR). Results: ROM of the SALIF specimens increased significantly in all loading directions (p ≤ 0.041), except for left AR (p = 0.053), whereas for TLIF it increased significantly in left LB (p = 0.033) and Flex (p = 0.015). NZ of SALIF showed increase in Flex–Ext and LB, whereas NZ of TLIF did not increase significantly in any motion direction. Conclusions: Axial compression loading caused loosening of SALIF in Flex–Ext and LB, but not TLIF at L5/S1 in low BMD specimens. Nevertheless, Post-cyclic ROM and NZ of SALIF is comparable to TLIF. This suggests that, neither construct is optimal for the use in patients with reduced BMD. [ABSTRACT FROM AUTHOR]

Introduction/Aims: Redundant nerve roots (RNRs) are abnormally elongated and tortuous nerve roots that develop secondary to degenerative spinal stenosis. RNRs have been associated with poorer clinical outcomes after decompression surgery; however, studies on their clinical characteristics are limited. This study aimed to investigate the association between RNRs and denervation potentials, that is, abnormal spontaneous activity (ASA), on electromyography. Methods: We retrospectively reviewed data of patients who underwent an electrodiagnostic study of the lower extremities between January 2020 and March 2023. Of these, patients with lumbar central spinal stenosis, as seen on magnetic resonance imaging, were included. We analyzed clinical and imaging data, including presence of ASA, and compared them according to the presence of RNRs. Multivariable logistic regression analysis was employed to identify factors associated with development of ASA. Results: Among the 2003 patients screened, 193 were included in the study. RNRs were associated with advanced age (p <.001), longer symptom duration (p =.009), smaller cross‐sectional area of the dural sac at the stenotic level (p <.001), and higher frequency of ASA (p <.001). Higher probability of ASA was correlated with greater RNR severity (p <.001). In the multivariable logistic regression analysis, ASA occurrence was associated with smaller cross‐sectional area, multiple stenotic sites, and severe‐grade RNRs. Discussion: The presence of RNRs, particularly severe‐grade RNRs, was identified as a significant risk factor for the development of ASA on electromyography. This finding may aid physicians in estimating the prognosis of patients with central spinal stenosis. [ABSTRACT FROM AUTHOR]

To measure and study the anatomical morphological data of the lumbar 5 to sacral 1 intervertebral space with the aid of CT and design an anatomical anterior lumbosacral 3D printed integrated interbody fusion for the treatment of degenerative lumbosacral spine diseases. 100 adults (50 of each sex) who underwent CT examination of the lumbar spine in our hospital were selected, and their lumbar 5 to sacral 1 intervertebral space anatomical data were measured, including the anterior lumbar convexity angle, different sagittal and coronal heights, and the sagittal and coronal diameters of the superior and inferior endplates. The measured data were also statistically analyzed, and morphological design and study of the 3D printed integrated fusion device in the anterior lumbosacral spine was performed by applying computer software. When comparing the coronal and sagittal diameters of the superior and inferior endplates from lumbar 5 to sacral 1, the differences were statistically greater in men than in women (P<0.001). The differences were not statistically significant when comparing the anterior convexity angle of the lumbosacral space (P>0.001). When comparing the height at different positions in the median sagittal plane, both males and females showed an anterior high and posterior low pattern. In the coronal plane, both males and females showed the highest height in the middle position (P<0.001), and there was no statistically significant difference between the left and the right height (P>0.001). CT can measure the anatomical data of the lumbosacral spinal hiatus more accurately. The 3D-printed anterior integrated fusion device of the lumbosacral spine designed according to the analysis of the data results is more in line with the anatomical structure of the lumbosacral spine, fits well with the superior and inferior endplates, and effectively restores the height and anterior convexity angle of the lumbosacral space. [ABSTRACT FROM AUTHOR]

Objectives: To assess the effect of oxygen-ozone therapy guided by percutaneous Computed Tomography (CT) compared to corticosteroids in individuals experiencing lower back pain (LBP) not attributed to underlying bone-related issues. Methods: A total of 321 patients (192 males and 129 females, mean age: 51.5 ± 15.1 years) with LBP were assigned to three treatment groups: group A) oxygen-ozone only, group B) corticosteroids only, group C) oxygen-ozone and corticosteroids. Treatment was administered via CT-guided injections to the intervertebral disc (i.e., intradiscal location). Clinical improvement of pain and functionality was assessed via self-reported pain scales and magnetic resonance (MR) and CT imaging. Results: At all follow-up times, the mean score of the numeric rating scale and the total global pain scale (GPS) of study groups receiving oxygen-ozone (groups A and C) were statistically significantly lower than the study group receiving corticosteroids only (group B), with p < 0.001. There was a statistically significant difference between groups A and C at 30 days for the numeric rating scale. Conclusions: The percutaneous application of oxygen-ozone in patients with LBP due to degeneration of the lumbosacral spine showed long-lasting significant pain reduction of up to two years post-treatment when compared to corticosteroids alone. Combination therapy of oxygen-ozone and corticosteroids can be useful as corticosteroids showed statistically significant improvement in LBP earlier than the oxygen-ozone-only treatment. [ABSTRACT FROM AUTHOR]

Abstract Objective S2‐alar‐iliac (S2AI) screw technique is widely used in spinal surgery, but it is rarely seen in the field of spinal tumors. The aim of the study is to report the preliminary outcomes of the freehand S2AI screw fixation after lumbosaral tumor resection. Methods The records of patients with lumbosacral tumor who underwent S2AI screw fixation between November 2016 to November 2020 at our center were reviewed retrospectively. Outcome measures included operative time, blood loss, complications, accuracy of screws, screw breach, and overall survival. Mean ± standard deviation or range was used to present continuous variables. Kaplan–Meier curve was used to present postoperative survival. Results A total of 23 patients were identified in this study, including 12 males and 11 females, with an average age of 47.3 ± 14.5 (range,15–73). The mean operation time was 224.6 ± 54.1 (range, 155–370 min). The average estimated blood loss was 1560.9 ± 887.0 (600–4000 ml). A total of 46 S2AI screws were implanted by freehand technique. CT scans showed three (6.5%) screws had penetrated the iliac cortex, indicating 93.5% implantation accuracy rate. No complications of iatrogenic neurovascular or visceral structure were observed. The average follow‐up time was 31.6 ± 15.3 months (range, 13–60 months). Two patients' postoperative plain radiography showed lucent zone around the screw. One patient underwent reoperation for wound delayed infection. At the latest follow‐up, eight patients had tumor‐free survival, 11 had survival with tumor, and four died of disease. Conclusion The freehand S2AI screw technique is reproducible, safe, and reliable in the management of lumbosacral spinal tumors.

Background: This paper outlines a summary of examination techniques for the thoracic and lumbosacral spine. It starts with observation, palpation and a range of movements followed by various special tests to identify thoracic and lumbosacral spine pathology. Methods: Bedside instruments used include a measuring tape, scoliometer and back range of motion instrument (BROM II). Discussion: Back flexion-extension, lateral flexion and rotation were assessed with bedside instruments. This would aid in increasing the accuracy and precision of objective measurement while conducting a clinical examination to determine the back range motion. Specific tests were used to localise specific anatomical locations and identify the spine pathology that can help the clinician to diagnose and treat the disease. [ABSTRACT FROM AUTHOR]

Objectives: To assess the effect of oxygen-ozone therapy guided by percutaneous Computed Tomography (CT) compared to corticosteroids in individuals experiencing lower back pain (LBP) not attributed to underlying bone-related issues. Methods: A total of 321 patients (192 males and 129 females, mean age: 51.5 ± 15.1 years) with LBP were assigned to three treatment groups: group A) oxygen-ozone only, group B) corticosteroids only, group C) oxygen-ozone and corticosteroids. Treatment was administered via CT-guided injections to the intervertebral disc (i.e., intradiscal location). Clinical improvement of pain and functionality was assessed via self-reported pain scales and magnetic resonance (MR) and CT imaging. Results: At all follow-up times, the mean score of the numeric rating scale and the total global pain scale (GPS) of study groups receiving oxygen-ozone (groups A and C) were statistically significantly lower than the study group receiving corticosteroids only (group B), with p < 0.001. There was a statistically significant difference between groups A and C at 30 days for the numeric rating scale. Conclusions: The percutaneous application of oxygen-ozone in patients with LBP due to degeneration of the lumbosacral spine showed long-lasting significant pain reduction of up to two years post-treatment when compared to corticosteroids alone. Combination therapy of oxygen-ozone and corticosteroids can be useful as corticosteroids showed statistically significant improvement in LBP earlier than the oxygen-ozone-only treatment.

Low backache is one of the most common reasons for outpatient visits and results from variety of causes. Persistent backache not responding to conservative therapy requires immediate evaluation and MRI has evolved as the modality of choice to know the cause and plan the management. The objective is to categorize the spinal causes of low backache using MRI. This study was done among 100 patients referred from various departments for MRI spine after taking proper consent in age group of 18-80 years over a period of one year. Out of 100 patients, majority belonged to 45-54 years age group with male: female ratio of 1.2:1. L4-L5 disc was affected most in this study. Degenerative disease-seen in 89% of total cases, disc bulge (89%), disc dessication (73%), disc herniation (28%), annular tear (27%). end plate changes (46%), marginal osteophytes (64%), Schmorl's nodes (29%), acute compression fracture (2%), pars interarticularis fracture (15%) ligament flavum hypertrophy (52%), facet joint arthropathy (7%), lumbar canal stenosis (21%), and nerve root compression (76%). Congenital causes- seen in 24% of total cases in the form of lumbosacral transition anomalies, spina bifida, scoliosis, perineural cysts, limbus vertebra and fusion anomalies. Infective spondylodiscitis- seen in 14% of total cases, commonly involving 25-34 year age group and D11-12 level. Spinal neoplasms- seen in 8% of total cases, commonly involved 45-54 year age group. Metastasis more common than primary spinal neoplasms. It can be concluded from this study that MRI is an accurate radiation free modality for evaluation of low back pain. [J Med Allied Sci. 2022; 12(2):76-83]

Objective. To analyze clinical outcomes and complication rates of transforaminal and interlaminar endoscopic decompression and open microsurgical operations performed for lumbosacral spinal canal stenosis. Material and Methods. The data of 60 literature sources selected in accordance with the inclusion and exclusion criteria in the PubMed, Science Direct, Google Scholar and Cochrane Library databases were systematized by evaluating diagnostic methods, clinical pictures and surgical treatment of the lumbar spinal canal stenosis. Original studies, case series and reviews containing information on surgical methods for the treatment of spinal stenosis at the lumbar level were analyzed. Results. The complication rate after transforaminal endoscopic decompression (relapses, infectious complications, damage to the dural membrane and spinal roots) does not exceed 2.7 %, which is significantly lower than that in open microsurgical operation (4.8–8.8 %). Endoscopic decompression and reconstruction of the spinal canal demonstrate good clinical outcomes, lower number of bed-days, readmissions, and good economic benefits. When stenosis is combined with instability of the spinal motion segment, performing only a decompressive operation in any volume does not give a significant clinical result, and stabilization surgery is required. Conclusion. The introduction of endoscopic reconstructive surgery for spinal canal stenosis in the lumbosacral spine is associated not only with technical progress and improvement of endoscopic optics, but also with the search for the causes of unsatisfactory results of open operations. Endoscopic interventions showed good clinical outcomes and a decrease in the complication rate. However, the evidence base needs to be expanded due to the lack of randomized trials to compare open decompression and stabilization, and endoscopic reconstructive surgeries in patients with various manifestations of spinal stenosis.

Abstract Background The biggest challenge in treating this diagnosis is the lack of literature focusing on regional interdependence. The current literature suggests a narrow and localized approach targeting plantar fascia and ankle/foot complex. The literature available on conservative treatment focused on utilizing various inflammatory modalities such as injections and extracorporeal shockwave therapy. The surgical approach targets Baxter’s nerve decompression techniques and releases techniques to the gastrocnemius and plantar fascia. The article focuses on utilizing manual therapy techniques to the lumbosacral spine and plantar fascia. In addition, the neurodynamic flossing targeted lateral plantar nerve mobility. Case presentation The patient is a 54-year-old African American female seen for right heel pain at Texas’s outpatient orthopedic physical therapy clinic. The patient had the diagnosis of plantar fasciopathy with negative Windlass testing. The patient was provided manual therapy interventions to the lumbosacral spine and plantar fascia to improve weight-bearing patterns and overall functional outcomes. Conclusion The manual therapy interventions to the lumbosacral spine and plantar fascia and flossing techniques to the lateral plantar nerve improved symptoms of heel pain. The patient showed improved outcomes with this approach.

Human movements are well organized and centralized at the lumbosacral junction of the body. To provide proximal stability and generate distal mobility, the Transverse Abdominis muscle plays a key role as a natural “corset”. The obesity, sedentary lifestyle and physical inactivity leads to nonuse wasting of this muscle and retraining is a major challenge. Thus there is a certain need to develop a device for strengthening this value adding muscles for bedridden population to very active individuals.This multiphasic study involves designing an electro pressure sensing device as per the curvature of spine and support of Auto-CAD model. The load cell sensor in the device identifies the pressure changes when an individual asks to flatten the lumbar curve or drawing in the abdomen.The validation of low back exerciser for activation of Transverse Abdominis assessed with MVC of EMG. The device was tested on normal individuals for efficiency of visual feedback to improve contraction of Transverse Abdominis. A testing phase observed the normal individuals (n=90) and low back pain patients (n=15) with mean age of (30.72±14.17) and (42.73±1.41) respectively. It was performed with and without feedback. An ethical approval and informed consent was obtained before the commencement of study.The present study revealed the validation MVC of Transverse Abdominis with Low back exerciser is 0.87. Low back exerciser validation for normal individuals with feedback was 0.95, without feedback was 0.93, for low back pain patients it was 0.97 .The low back exerciser was found to be a valid tool for testing and retraining of the Transverse Abdominis and it must be taken into consideration for routine practice for improving proximal stability with and without LBP. [ABSTRACT FROM AUTHOR]

Objective: To compare anatomy of sacral hiatus between the genders of case and control groups. To determine significance of hiatal variations between the genders of cases and controls. Study Design: Case-control study. Setting: PNS Shifa Hospital Karachi. Period: January 2020 to June 2020. Material & Methods: Total of 178 participants aged 18-65 years were enrolled in the study. Approval was taken from Ethical Review Committee of Bahria University Medical and Dental College (BUMDC). Participants were arranged into case and control groups. The hiatus and its dimensions were identified on lumbosacral spine radiographs inferior to the sacral spine using spinous and alar processes. Data was recorded in subject evaluation proforma and analyzed using SPSS version 23.0. Results: The V shaped hiatus was more prevalent in males, whereas in females it was U. The most common variant was the irregular shape. The hiatal apex in males was at S3. In females it was at S2. The base was seen at S5 in both genders. The mean length, anteroposterior diameter and transverse width of the hiatus was more in males as compared to females. The mean values of all parameters were less in cases as compared to controls. Conclusion: The V shaped sacral hiatus were most prevalent in males, whereas U shape in females. The hiatal apex was at a lower level in males, whereas the level of base was similar in both genders. The hiatus was shorter in cases of backache in both genders as compared to controls. The anteroposterior diameter and width were also less in cases as compared to the healthy controls. [ABSTRACT FROM AUTHOR]

Objective: S2‐alar‐iliac (S2AI) screw technique is widely used in spinal surgery, but it is rarely seen in the field of spinal tumors. The aim of the study is to report the preliminary outcomes of the freehand S2AI screw fixation after lumbosaral tumor resection. Methods: The records of patients with lumbosacral tumor who underwent S2AI screw fixation between November 2016 to November 2020 at our center were reviewed retrospectively. Outcome measures included operative time, blood loss, complications, accuracy of screws, screw breach, and overall survival. Mean ± standard deviation or range was used to present continuous variables. Kaplan–Meier curve was used to present postoperative survival. Results: A total of 23 patients were identified in this study, including 12 males and 11 females, with an average age of 47.3 ± 14.5 (range,15–73). The mean operation time was 224.6 ± 54.1 (range, 155–370 min). The average estimated blood loss was 1560.9 ± 887.0 (600–4000 ml). A total of 46 S2AI screws were implanted by freehand technique. CT scans showed three (6.5%) screws had penetrated the iliac cortex, indicating 93.5% implantation accuracy rate. No complications of iatrogenic neurovascular or visceral structure were observed. The average follow‐up time was 31.6 ± 15.3 months (range, 13–60 months). Two patients' postoperative plain radiography showed lucent zone around the screw. One patient underwent reoperation for wound delayed infection. At the latest follow‐up, eight patients had tumor‐free survival, 11 had survival with tumor, and four died of disease. Conclusion: The freehand S2AI screw technique is reproducible, safe, and reliable in the management of lumbosacral spinal tumors. [ABSTRACT FROM AUTHOR]

Study Design Retrospective case series. Purpose This study aimed to analyze how the sagittal spinopelvic alignment is influenced by an attempted surgical reduction of the L5–S1 segment in patients with high-grade spondylolisthesis (HGS). Overview of Literature Conventional treatment strategies stress the importance of achieving fusion across the lumbosacral junction in patients with HGS. The role of reduction in this subset of patients is controversial. Methods This is a retrospective case series of 35 patients with Meyerding grades III, IV, or V spondylolisthesis who underwent surgical treatment in our institution. Before and after surgery, we took standing lateral radiographs from L1 vertebra to pelvis, including the femoral heads, and measured the slip grade, pelvic incidence, sacral slope, pelvic tilt, lumbosacral angle, and lumbar lordosis. Patients were subdivided into “balanced” and “unbalanced” pelvis groups. To determine the effect and correlation of reduction on these spinopelvic parameters, we statistically compared the pre- and postoperative measurements. Results The average follow-up was 9 months (range, 3–169 months). Slip grade improved from an average 74.0%±13.2% to 30.0%±14.0% (p

A review of the literature on performing spinopelvic fixation for injuries and various pathologies of the spine and pelvis is presented. The review is analytical in nature and was carried out using databases of medical literature and search resources of PubMed and eLibrary. The following aspects are highlighted: the relevance and indications for performing spinopelvic fixation and its anatomical and biomechani- cal features. The historical aspects of the development of methods for performing spinopelvic fixation are considered and structured. The analysis of various methods of spinopelvic fixation (using hooks, screw insertion into the S2 sacral wings, L-shaped Luque rods, distrac- tors, transiliac rods, Jackson, Harrington and Galveston techniques) was carried out. The features of surgical techniques, their advan- tages, disadvantages and complications are considered.

Low backache is one of the most common reasons for outpatient visits and results from variety of causes. Persistent backache not responding to conservative therapy requires immediate evaluation and MRI has evolved as the modality of choice to know the cause and plan the management. The objective is to categorize the spinal causes of low backache using MRI. This study was done among 100 patients referred from various departments for MRI spine after taking proper consent in age group of 18-80 years over a period of one year. Out of 100 patients, majority belonged to 45-54 years age group with male: female ratio of 1.2:1. L4-L5 disc was affected most in this study. Degenerative disease-seen in 89% of total cases, disc bulge (89%), disc dessication (73%), disc herniation (28%), annular tear (27%). end plate changes (46%), marginal osteophytes (64%), Schmorl's nodes (29%), acute compression fracture (2%), pars interarticularis fracture (15%) ligament flavum hypertrophy (52%), facet joint arthropathy (7%), lumbar canal stenosis (21%), and nerve root compression (76%). Congenital causesseen in 24% of total cases in the form of lumbosacral transition anomalies, spina bifida, scoliosis, perineural cysts, limbus vertebra and fusion anomalies. Infective spondylodiscitis-seen in 14% of total cases, commonly involving 25-34 year age group and D11-12 level. Spinal neoplasms-seen in 8% of total cases, commonly involved 45-54 year age group. Metastasis more common than primary spinal neoplasms. It can be concluded from this study that MRI is an accurate radiation free modality for evaluation of low back pain. [ABSTRACT FROM AUTHOR]

Purpose: Surgical treatment of jumper's fractures is a highly demanding situation for the surgeon due to its rareness and frequent association with severe concomitant injuries. There is no current consensus regarding a standard treatment approach, thus reducing quality of care. Our objectives were to describe, apply and assess a novel surgical technic. Methods: The presented research is an observational retrospective study of patients who underwent the described novel surgical intervention in a level 1 trauma center. We conducted analyses of the patient cohort using patient-related outcome measures at least 1 year after surgery, as well as investigating pain, quality of life and the clinical effectiveness of the procedure. Results: A total of 24 patients (17 male and 7 female) with an average age 47 ± 16.3 years were included. ISS scores ranged from 9 to 66 with a mean ISS of 40 ± 15. Clinical scores exist of 15 out of 24 patients (62.5%). The mean VAS score was 53.7 ± 12.9. The mean EQ-5D index was 0.68 ± 0.22. Significant negative correlation existed between the ISS value and the EQ-5D index (r = − 0.704; p < 0.005) and EQ-5D VAS (r = − 0.809; p < 0.001). Anatomical reduction was achieved in all patients (n = 24). Radiological follow-up was performed in 58%. Conclusion: We present one of the largest studies with operatively treated jumper's fractures of the sacrum. The technique is capable of reproducibly restoring the physiological anatomy of the patient and allows pain-adapted mobilization. [ABSTRACT FROM AUTHOR]

In this study, we intended to describe a human case of lumbosacral canal sparganosis in People's Republic of China (China). A 56-year-old man was admitted to Xiangya Hospital Central South University in Changsha, Hunan province, China after having an experience of perianal pain for a week. An enhancing mass, a tumor clinically suggested, was showed at the S1-S2 level of the lumbosacral spine by the examination of magnetic resonance imaging (MRI) with gadolinium contrast. The patient was received the laminectomy from S1 to S2, and an ivory-white living worm was detected in inferior margin of L5. In ELISA-test with cerebrospinal fluid (CSF) and serum samples, anti-sparganum antibodies were detected. He had a ingesting history of undercooked frog meat in his youth. By the present study, a human case of spinal sparganosis invaded in lumbosacral canal at the S1-S2 level was diagnosed in China. Although the surgical removal of larvae is known to be the best way of treatment for sparganosis, we administered the high-dosage of praziquantel, albendazole and dexamethasone to prevent the occurrence of another remain worms in this study. [ABSTRACT FROM AUTHOR]

Anomalies of the aortoiliac arteries are rarely reported and are generally discovered incidentally on imaging performed mostly for investigation of other medical concerns. While aortic bifurcation is typically reported at the fourth lumbar vertebra, variations are possible. We present a case with very low aortic bifurcation, almost at the level of S2, with various other anomalies including a corkscrew left common iliac artery passing just anterior to the bladder dome with pulsation noted during cystoscopy. An ectopic right kidney was also noted. To our knowledge, these vascular anomalies have not been reported previously.

Study Design: Retrospective case series. Purpose: This study aimed to analyze how the sagittal spinopelvic alignment is influenced by an attempted surgical reduction of the L5-S1 segment in patients with high-grade spondylolisthesis (HGS). Overview of Literature: Conventional treatment strategies stress the importance of achieving fusion across the lumbosacral junction in patients with HGS. The role of reduction in this subset of patients is controversial. Methods: This is a retrospective case series of 35 patients with Meyerding grades III, IV, or V spondylolisthesis who underwent surgical treatment in our institution. Before and after surgery, we took standing lateral radiographs from L1 vertebra to pelvis, including the femoral heads, and measured the slip grade, pelvic incidence, sacral slope, pelvic tilt, lumbosacral angle, and lumbar lordosis. Patients were subdivided into "balanced" and "unbalanced" pelvis groups. To determine the effect and correlation of reduction on these spinopelvic parameters, we statistically compared the pre- and postoperative measurements. Results: The average follow-up was 9 months (range, 3-169 months). Slip grade improved from an average 74.0%±13.2% to 30.0%±14.0% (p <0.001), and lumbosacral angle reduced from an average 32.0°±11.6° to 6.0°±0.6° (p <0.001). Although the pelvic tilt was reduced, this was not significant. There was a modest negative correlation between the reduction in slip grade and the increase in sacral slope (r =-0.3, p =0.06). At follow-up, five patients improved, from an unbalanced pelvis to a balanced pelvis. Fusion occurred in 33 patients (95%). Conclusions: Surgical reduction of HGS restores the lumbosacral alignment. However, a similar trend is not noted with the pelvic parameters. [ABSTRACT FROM AUTHOR]

The observations of the study were focused on the lumbosacral region of the spine in cats in order to identify some peculiarities or abnormalities in the anatomical conformation regarding the number of the vertebra or other morphological aspects. For this purpose were analyzed the radiographs of the lumbosacral region of 63 feline patients of a veterinary clinic, both males and females, 1-9 years aged, which showed various symptoms, especially locomotor. The x-ray exam revealed sundries pathologies of the spine, but among them in a cat of European breed it was remarked an abnormal anatomical conformation of the lumbosacral spine consisting in the sacralization of the last lumbar vertebra. It was noticed that the last lumbar vertebra is fused with the first sacral one in a large degree, both vertebral bodies and the transverse processes being merged, the sacrum bone containing four sacral vertebra instead of three, as normally does. It was counted also three ventral sacral foramina, instead of two. The particular characteristics noticed conducted to the observation that the last lumbar vertebra represents in fact a lumbosacral transitional vertebra (LTV) which in cats occurs at a low rate. [ABSTRACT FROM AUTHOR]

Spinal epidural arteriovenous fistulas (SEAVFs) are rare lesions with a low risk of hemorrhage. Most patients with lumbosacral SEAVFs with hemorrhagic events will develop a spinal epidural hematoma from epidural venous pouches. To the best of our knowledge, we have reported the first case of a lumbosacral SEAVF presenting with remote intramedullary hemorrhage in the conus medullaris. A 56-year-old man presented with sudden-onset severe paraparesis and bowel/bladder dysfunction. Magnetic resonance imaging of the thoracic and lumbosacral spine showed acute intramedullary hemorrhage in the conus medullaris surrounded by spinal cord congestion extending to T8, with perimedullary flow voids along the ventral and dorsal cord surfaces. Magnetic resonance angiography and spinal angiography confirmed the presence of a SEAVF with a large lumbosacral epidural venous lake supplied by dorsal somatic branches of bilateral L4 segmental arteries. Initially, the intradural venous drainage had been misinterpreted as a single route. The patient underwent surgical interruption of the dilated intradural draining vein after embolization of the feeding vessels. Another small intradural venous drainage route was found on the follow-up angiogram. The second operation with occlusion of the initial part of the epidural venous lake was sufficient to cure this lesion. With the significant improvement of our patient after treatment of the SEAVF, we speculated that the intramedullary hemorrhage, which had occurred in the area of spinal cord edema, might have resulted from severe venous hypertension, rather than hemorrhagic infarction of the spinal cord. Careful evaluation of the angioarchitecture of SEAVFs is imperative to determine the most effective treatment modality. [ABSTRACT FROM AUTHOR]

Salmonella belongs to the family Enterobacteriaceae. The various members of the genus cause diseases that are important public health problems. Apart from causing typhoid, Salmonella can cause an array of diseases ranging from osteomyelitis to meningitis, though rare. Herein, authors report one such uncommon scenario, in an otherwise healthy 40-year-old female who presented with lower back pain. Magnetic Resonance Imaging (MRI) was suggestive of lumbosacral spondylodiscitis and she underwent a spine stabilisation surgery. The pathogen was confirmed to be Salmonella Typhi by microbiological workup. She responded well to treatment with ceftriaxone. This case report implies the significance of culture studies in the early management of the patient. It is imperative for the diagnosis, as the symptoms of the aforementioned disease are usually non-specific and imaging studies are indiscernible from spine tuberculosis.

Objective. To analyze the types and frequency of adverse drug reactions to local intrawound application of vancomycin powder in patients after posterior decompression and stabilization in the lumbosacral spine. Material and Methods. Clinical series published in 2011–2017 were analyzed. At the first stage, Medline and PubMed databases were searched for English-language literature sources using the keywords «intrawound vancomycin», «surgical site infection», and «posterior lumbar fusion», and e-Library for Russian-language sources using «local application of vancomycin powder», «infection in the surgical site», and «posterior decompression and stabilization». At the second stage, abstracts of articles were examined, and publications that did not meet the research criteria were excluded. At the third stage, the full texts of the selected articles were reviewed for compliance with inclusion criteria, as well as references for relevant studies. Results. Nineteen clinical studies (16 retrospective and 3 prospective) with a total of 13,077 patients were selected for a systematic re- view. In 55.3 % (7,236) of posterior lumbosacral surgery cases, vancomycin powder was applied locally to prevent surgical site infection. Among the entire cohort of patients, unwanted drug reactions were detected in 2.19 % of patients. Conclusions. Local application of vancomycin powder is associated with a low incidence of unwanted drug reactions.

BACKGROUND: Deterministic and stochastic effects deleterious side effects arising from the use of ionizing radiation in diagnostic radiology, radiation therapy, and nuclear medicine. The breast is a radiosensitive organ that is often 'shielded' with a simple cotton gown when contiguous or fairly distant anatomical regions are imaged radiographically. OBJECTIVE: To quantify the amount of scattered radiation to breasts during x-ray and CT investigations with a view to finding evidence for apparel shielding during such procedures in the locality. METHODS: Thermoluminescent dosimeters were used to quantify scattered radiation dose in fifty patients each for computed tomography (CT) and computed radiography (CR). Absorbed dose (mGy) were subjected to statistical analysis. Central tendencies and dispersion were noted. Furthermore, a paired-sample t-test was done to test for statistically significant difference in mean absorbed dose by both breasts. Difference found justified the necessity for shielding during radiographic examinations. RESULTS: Scattered radiation reached the breasts in both procedures, and with a range of 1.28 - 12.6 mGy (CT) and 1.02 - 3.63 mGy. There was enormous reduction in dose between unshielded and shielded breasts in CT (113 %) and CR (32.2 %), with the difference being statistically significant (p < 0.05). CONCLUSION: Scattered radiation to the breasts were greatly and significantly reduced when shielding was applied. We strongly urge radiographers to practice shielding of contiguous and distant organs during procedures involving ionizing radiation. [ABSTRACT FROM AUTHOR]

Study Design: Nationwide Readmissions Database Study.Objective: To investigate the patterns of readmissions and complications following hospitalization for elective single level anterior lumbobsacral interbody fusion.Summary Of Background Data: Lumbar interbody spine fusions for degenerative disease have increased annually in the United States, including associated hospital costs. Anterior lumbar interbody fusions (ALIFs) have become popularized secondary to higher rates of fusion compared with posterior procedures, and preservation of posterior elements. Prior national databases have sought to study readmission rates with some limitations due to older diagnosis and procedure codes. The newer 2016 International Classification of Diseases Tenth Revision, Clinical Modification (ICD-10 CM) includes more specification of the surgical site.Methods: We utilized the 2016 United States Nationwide Readmissions Database (NRD), this nationally representative, all-payer database that includes weighted probability sample of inpatient hospitalizations for all ages. We identified all adults (≥ 18 yrs) using the 2016 ICD-10 coding system who underwent elective primary L5-S1 ALIF and examined rates of readmissions within 90 days of discharge.Results: Between January and September 2016, a total of 7029 patients underwent elective stand-alone L5-S1 ALIF who were identified from NRD of whom 497 (7.07%) were readmitted within 90 days of their procedure. No differences in sex were appreciated. Medicare patients had statistically significant higher readmission rates (47.69%) among all payer types. With respect to intraoperative complications, vascular complications had statistically significant increased odds of readmission (OR, 3.225, 95% CI, 0.59 -1.75; P = 0.0001). Readmitted patients had higher total healthcare costs.Conclusion: The 90-day readmission rate following stand-alone single level lumbosacral (L5-S1) ALIF was 7.07%. ALIF procedures have increased in frequency, and an understanding of the comorbidities, age-related demographics, and costs associated with 90-day readmissions are critical. Surgeons should consider these risk factors in preoperative planning and optimization.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Spinal sparganosis associated with filum terminale arteriovenous fistula (FTAVF) has not been reported in the literature. In previous studies, these 2 rare diseases were usually reported separately. We report the first case of spinal sparganosis with concomitant FTAVF. Spinal sparganosis associated with FTAVF manifested in a middle-aged man with progressive back pain and paraparesis. Magnetic resonance imaging of the lumbosacral spine revealed large intradural mass–like lesions involving the conus medullaris and entire cauda equina. Additionally, there was degenerative spinal stenosis at the level of L2-3 to L5-S1. Magnetic resonance imaging of the thoracic spine disclosed abnormal hypersignal intensity extending from the level of the conus medullaris to T7 with tortuous intradural flow voids along the ventral more than dorsal surfaces of the spinal cord. Magnetic resonance angiography and spinal angiography confirmed FTAVF at the level of L3-4. The patient underwent surgical removal of the granulation tissues with lysis adhesions and obliteration of the FTAVF simultaneously in the same surgical session. Histologic findings were consistent with sparganosis. The formation of FTAVF in the present case may have resulted from severe spinal canal stenosis caused by lumbar spondylosis and spinal sparganosis, inducing chronic inflammation and severe adhesion of spinal nerve roots. This evidence indicates that FTAVF may have been acquired. [ABSTRACT FROM AUTHOR]

Background. Сaudal epidural blocks — minimally invasive method of treating pain syndromes of the low back through the introduction of drugs into the epidural space through hiatus sacralis. The purpose of the study was to analyze the results of the treatment for pain syndromes of lumbosacral spine in its degenerative-dystrophic diseases by сaudal epidural blocks. Materials and methods. Retrospective analysis was performed in 49 patients (23 men and 26 women) aged 55.4 ± 2.1 years with complaints of low back pain, who were treated by сaudal epidural blocks. Group 1 — 27 persons with protrusions or herniated discs. Group 2 — 22 patients with lumbar spinal stenosis. The period of observation was at least 3 months after the procedure. Evaluation of treatment results was carried out by Visual analogue scale for pain assessment, Roland-Morris indices of the quality of life and Oswestry Disability Index (ODI). The number of the procedures performed was 1–3. Results. In group 1, it was marked a persistent regression of pain syndrome from 7.07 ± 1.10 cm to 3.29 ± 1.29 cm after treatment, 4.02 ± 1.64 cm — in 1 month, 4.07 ± 1.81 cm — in 3 months (p < 0.05). In group 2, we observed less pronounced and lasting regression of pain syndrome, from 7.18 ± 1.29 cm to 3.50 ± 1.33 cm after the procedure, 3.86 ± 1.72 cm — in 1 month, 4.18 ± 2.03 cm — in 3 months (p < 0.05). Regression of pain syndrome is also strongly correlated with Roland-Morris indices of the quality of life and ODI. Conclusions. Сaudal epidural block is an effective treatment of low back pain with hernias and protrusions of intervertebral discs, as well as lumbar spinal stenosis. Regression of pain correlated with improvement of quality of life according to the Roland-Morris disability questionnaires and ODI at all stages of monitoring.

Study Design: Retrospective cohort study.Objective: The purpose of this study is to characterize the utilization and costs of MNTs prior to spinal fusion surgery in patients with symptomatic lumbar stenosis or spondylolisthesis.Summary Of Background Data: The costs and utilization of long-term maximal nonoperative therapy (MNT) can be substantial, and in the current era of bundled payments, the duration of conservative therapy trials should be reassessed.Methods: A large insurance database was queried for patients with symptomatic lumbar stenosis or spondylolisthesis undergoing index lumbar decompression and fusion procedures between 2007 and 2016. This database consists of 20.9 million covered lives and includes private/commercially insured and Medicare Advantage beneficiaries. Only patients with lumbar stenosis or spondylolisthesis and those continuously active within the insurance system for at least 5 years prior to the index operation were eligible.Results: A total of 4133 out of 497,822 (0.8%) eligible patients underwent 1, 2, or 3-level posterior lumbar instrumented fusion. 20.8% of patients were smokers, 44.5% had type II DM, and 38.2% were obese (body mass index [BMI] >30 kg/m). Patient MNT utilization was as follows: 66.7% used nonsteroidal anti-inflammatory drugs (NSAIDs), 84.4% used opioids, 58.6% used muscle relaxants, 65.5% received lumbar epidural steroid injections (LESI), 66.6% attended 21.1% presented to the emergency department (ED), and 24.9% received chiropractor treatments. The total direct cost associated with all MNT prior to index spinal fusion was $9,000,968; LESI comprised the largest portion of the total cost of MNT ($4,094,646, 45.5%), followed by NSAIDS ($1,624,217, 18.0%) and opioid costs ($1,279,219, 14.2%). At the patient level, when normalized per patient utilizing therapy, an average $4010 was spent on nonoperative treatments prior to index lumbar surgery.Conclusion: Assuming minimal improvement in pain and functional disability after maximum nonoperative therapies, the incremental cost-effectiveness ratio (ICER) for MNTs could be highly unfavorable.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Purpose: U-shaped sacral fractures are extremely rare injuries that usually occur as a result of falls from considerable heights. Almost all treatment methods described to date aim solely at stabilizing the fracture but do not contribute to supporting the reduction of such fractures. Using existing implants the purpose of this study is to present a surgical technique that facilitates both the reduction and the stabilization of these injuries. The presented technique was evaluated in a series of three cases.Methods: Polyaxial pedicle screws were placed through vertebral bodies L4 and L5. Two long pedicle screws were implanted in the posterior iliac spine. The lumbar pedicle screws were held with two longitudinal rods, and the pelvic screws with one transverse connecting rod. The lumbar longitudinal and pelvic transverse rods were connected via two hinge-like connecting elements. First, distraction was performed between lumbar pedicle screws L5 and the sacral transverse rod. Lordosis was then restored via the hinge joint, thereby eliminating kyphosis. After tightening all moving elements, the fracture was reduced and stabilized.Results: Computed tomography documented anatomical reduction and fracture healing was achieved in all cases. Two of three patients could be fully mobilized immediately; mobilization of the third patient was delayed due to multiple injuries. Two patients showed neurological symptoms. In one case, complete remission was achieved within 3 weeks, while in the other patient a clear improvement was observed. In all cases, the implant was removed after 8-12 months. There were no post-operative complications, such as infections, wound-healing disorders, neurological deterioration, implant failure, or premature loosening.Conclusions: The surgical procedure was successful, since it considerably facilitated reduction, thereby shortening surgery time. The stabilization was sufficient to fully mobilize the patients. The procedure is based on existing implant components and is thus routinely available. [ABSTRACT FROM AUTHOR]

Objective. To analyze the results of treatment of degenerative spine disease with the use of nitinol rods for lumbosacral fixation as compared with conventional rigid fixation. Material and Methods. The prospective randomized study included 75 patients (34 males, 41 females; mean age 43 years) with degenerative lesion at the L5–S1 level. Surgical treatment was performed with nitinol rods in 35 patients (Group 1), and with standard titanium rods in 40 patients (Group 2). Clinical and radiological results were assessed in 1.5 years after surgery. Results. The VAS leg-and-back, ODI, and SF-36 scores showed improvement in patients of both groups such as a significant reduction in pain intensity and improvement in psychological and physical health. The X-ray examination showed the restoration of the lumbar lordosis in both groups. In Group 1, there was no evidence of screw instability, bone resorption around screws and the adjacent segment disease, and functional radiography demonstrated preservation of mobility (5.0° ± 1.2°). There were seven patients with pseudoarthrosis, and six – with adjacent segment disease in Group 2, surgi- cal intervention was required in four of them. Conclusion. Transpedicular fixation in the lumbosacral spine using nitinol rods is an effective technology allowing for mobility preservation in combination with stable fixation.

Background Giant invasive spinal schwannomas (GISSs) comprise a rare, specific subtype of schwannomas that extend >2 spinal levels, erode vertebral bodies, and invade extraspinal tissues. Optimal surgical management of resulting spinal instability has yet to be determined, and overall there is limited published literature on GISS. We report an innovative method used to treat a rare case of lumbosacral GISS using a triangular frame reconstruction to reconnect the spinal column to the pelvis after tumor debulking. This method of using femur allograft in lieu of metal rods can promote stronger bony fusion of the construct. Case Description A 19-year-old woman presented with worsening lower back pain, which was due to a giant invasive spinal schwannoma that invaded the L4-S1 vertebral bodies and extended intrathecally from T10-S2, compromising the stability of her spine. The primary resection of the tumor was completed in 3 stages and was followed by a multilevel fusion involving a triangular construct made of femur allograft to reconnect the unstable spinal column with the pelvis. Maximal resection of the tumor was achieved with early rehabilitation. Pseudoarthrosis occurred, which was successfully fused after revision with the addition of an implanted bone stimulator. Seven years later, she remains in stable neurological condition. Conclusions We recommend the use of femur allograft in triangular frame constructs for lumbosacral GISS to foster more stable, physiologic spinopelvic fusion. [ABSTRACT FROM AUTHOR]

Spondylolisthesis is a complex and variable disease pathophysiological entity that has long been the subject of numerous investigations. The complexity of the disorder and the variety of treatment methods require an effective classification system that is easy to remember and use in practice. Classification systems have undergone many modifications ranging from Meyerding's system by Taylard, Newman, Wiltse, Meschan to the Spine Deformity Study Group (SDSG), whose formulation seems to be complex, but is simple to use. Many classification systems are still widely used so different treatment strategies can be defined. Hence the knowledge of individual systems is required for effective recognition and treatment of this defect of the spine. This article discusses several successive classification systems for vertebral grading, which are in addition to the previously presented classification.

An inflammatory pseudotumor (IPT) is a rare benign lesion, characterized by nonneoplastic proliferation of inflammatory cells and presence of intermingling collagen fibers. IPT commonly occurs in the lungs and orbita, while an intraspinal IPT is extremely rare. IPT can mimic both clinically and radiologically malignant processes, and making a definitive preoperative diagnosis is often difficult. Recently, 18-fluorine fluorodeoxyglucose (18F-FDG) has been reported to accumulate in IPT in the lung, spleen, liver, pancreas, colon, orbit, mediastinum, and mesentery. However, to the best of our knowledge, accumulation of 18F-FDG has not been reported in lumbosacral intraspinal IPT. Herein, we report a case of IPT in the epidural space of the lumbar spine, using the imaging findings of 18F-FDG positron emission tomography-computed tomography (PET/CT) and contrastenhanced magnetic resonance imaging (MRI). This is the first case of IPT in the epidural space, depicted by 18F-FDG PET/CT, which revealed a homogeneous, intense 18F-FDG uptake.

Background: Bilateral Hamstrings muscles shortening is a common condition found in symptomatic and asymptomatic subjects. Tightness of this muscle can play a role in low back pain, postural deficits, lumbar spine disorders and sport related injuries. Purpose of this study: was to investigate the influence of bilateral hamstrings muscles shortening on some radiological parameters of lumbosacral spine. Materials and Methods: Thirty normal subjects of both genders participated in this study. Subjects were classified into two equal groups; Group A: The Control group: was consisted of fifteen subjects. They were without hamstring shortening with mean age, weight, height and BMI were 26.8 ± 4.34 years, 74.6 ± 17.45 kg, 174 ± 15.5 cm, and 24.28 ±2.67 kg/m2 respectively. Group B: The Study group: was consisted of fifteen subjects. They were with bilateral shortening of the hamstrings with mean age, weight, height and BMI were 25.8 ±3.91 years, 66 ± 9.69 kg, 164.2 ±7.43 cm, and 24.38± 2.81 kg/m2 respectively. The shortening of the hamstrings was assessed with Active Knee Extension Test, and radiological parameters of lumbosacral spine were assessed from X-Ray image using Paxera Viewer Software. Results: This study showed that there was a significant difference in some radiological parameters of lumbosacral spine (Lumbar lordosis angle, Lumbosacral angle and Sacral inclination angle) in cases of bilateral hamstrings muscle shortening as p value was (<0.05). Conclusion: Bilateral hamstrings muscle shortening has significant effect on lumbosacral spine. [ABSTRACT FROM AUTHOR]

Background. Сaudal epidural blocks - minimally invasive method of treating pain syndromes of the low back through the introduction of drugs into the epidural space through hiatus sacralis. The purpose of the study was to analyze the results of the treatment for pain syndromes of lumbosacral spine in its degenerative-dystrophic diseases by сaudal epidural blocks. Materials and methods. Retrospective analysis was performed in 49 patients (23 men and 26 women) aged 55.4 ± 2.1 years with complaints of low back pain, who were treated by сaudal epidural blocks. Group 1 - 27 persons with protrusions or herniated discs. Group 2 - 22 patients with lumbar spinal stenosis. The period of observation was at least 3 months after the procedure. Evaluation of treatment results was carried out by Visual analogue scale for pain assessment, Roland-Morris indices of the quality of life and Oswestry Disability Index (ODI). The number of the procedures performed was 1-3. Results. In group 1, it was marked a persistent regression of pain syndrome from 7.07 ± 1.10 cm to 3.29 ± 1.29 cm after treatment, 4.02 ± 1.64 cm - in 1 month, 4.07 ± 1.81 cm - in 3 months (p < 0.05). In group 2, we observed less pronounced and lasting regression of pain syndrome, from 7.18 ± 1.29 cm to 3.50 ± 1.33 cm after the procedure, 3.86 ± 1.72 cm - in 1 month, 4.18 ± 2.03 cm - in 3 months (p < 0.05). Regression of pain syndrome is also strongly correlated with Roland-Morris indices of the quality of life and ODI. Conclusions. Сaudal epidural block is an effective treatment of low back pain with hernias and protrusions of intervertebral discs, as well as lumbar spinal stenosis. Regression of pain correlated with improvement of quality of life according to the Roland-Morris disability questionnaires and ODI at all stages of monitoring. [ABSTRACT FROM AUTHOR]

Objective We present the largest known consecutive series of patients with epidural lipomatosis (EL) to characterize demographics and clinical symptoms of patients with EL on magnetic resonance imaging (MRI), and compare these characteristics against a matched control group. Methods Patients evaluated for pathology requiring lumbar MRI imaging between September 2010 and September 2015 were retrospectively reviewed and included in this study if they were diagnosed with EL on a radiologic note during any visit to our medical center. One hundred ninety-nine patients fulfilled the study criteria and were included in the study cohort. A separate patient cohort of 199 unique, age- and gender-matched controls without lumbosacral EL was generated from a database of patients with lumbar MRI imaging during the same period. Results Average age at diagnosis was 54.9 years (range, 25–84 years). One hundred thirty-three patients (66.8%) were men. On univariate analysis, patients with EL were more likely to have history of smoking (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.23–2.94, P = 0.004), diabetes mellitus type 2 (OR 2.17, 95% CI 1.33–3.56, P = 0.002), or be on disability (OR 4.43, 95% CI 2.48–7.91, P < 0.001). Furthermore, patients with EL had significantly increased median body mass index compared with controls (36.7 vs. 29.4 kg/m 2 ; P < 0.001). Conclusions Patients with lumbosacral EL tend to be obese with a high incidence of type 2 diabetes mellitus, suggesting that this pathology may be a sequela of metabolic syndrome. Future research topics should include the pathogenesis of EL, as well as treatment outcomes of surgical versus primary care management. [ABSTRACT FROM AUTHOR]

Purpose: Pelvic incidence is a position- and posture-independent parameter used to quantify sagittal balance of the spine, sacrum, pelvis and hips. Its functional consequences have been associated with a number of different pathologies of the spine. However, there exists considerable controversy over which demographic features contribute to the development of pelvic incidence.Methods: 880 cadaveric skeletons from the Hamann-Todd Osteological Collection were obtained. The innominate bones and sacrum were reconstructed, and pelvic incidence was measured using a previously validated technique. Specimens with obvious fracture, infection, or rheumatologic conditions were excluded from study. Descriptive data of age at the time of death, gender, race and height were collected.Results: The average pelvic incidence was 46.0° ± 11.0°. Pelvic incidence did not change with age (r = 0.026, p = 0.288). There was no difference in pelvic incidence measurements between females and males (47.2° ± 13.8° vs. 45.8° ± 10.4°, respectively; p = 0.257), although this analysis was under-powered. Pelvic incidence was higher in African-Americans compared to Caucasians (48.9° ± 11.0° vs. 44.9° ± 10.8°; p = 0.001). There was no association between height and pelvic incidence (r = -0.042, p = 0.164).Conclusions: This study represents the largest single cohort of pelvic incidence measurements reported in the literature. Our data suggest that pelvic incidence does not change with age or height, although racial differences do exist. As spine care providers increasingly rely on pelvic incidence as an important means to quantify sagittal balance, the normative data provided herein will provide an essential reference. [ABSTRACT FROM AUTHOR]

Background: Back pain and sciatica are very common in adult persons. These cause a great loss of working hours with financial loss of individual and the nation. Very careful evaluation must be done to treat these patients. Injudicious treatment, whether medical or surgical, may aggravate the sufferings. Objective: To study immediate and long term effect of the prolapsed intervertebral disc surgery. Materials and Methods: This observational study was done in Enam Medical College & Hospital, Savar, Dhaka during January 2007 to June 2011. Sixty four patients operated during this period for prolapsed lumbar intervertebral disc were included in the study. Fifty six (88%) were male and 8 (12%) were female. Age range was 30 to 50 years. Most of the patients presented with back pain and sciatica with no definite history of trauma or weight lifting. Diagnosis was confirmed by MRI. Results: Sixty (94%) patients had no pain after surgery and only 4 patients had occasional pain. Conclusion: Maintenance of strict criteria for the surgery yields very good result.

Actinomycosis is a gram positive commensal bacteria. In predisposed individuals like immunocompromised patients, it can cause myriad lesions involving virtually any organ of the body. Involvement of spinal cord with its compression is rare though. We are reporting here a case of 30-year-old immunocompetent male who presented with weakness of left lower limb. Radiologically differential diagnosis was tuberculosis or lymphoma of spinal cord. Histopathology showed actinomycotic colonies that were periodic Schiff (PAS) positive and revealed gram positive filamentous bacteria.

The analysis of application of medical physical culture is resulted in a physical rehabilitation at the osteochondrosis of the lumbosacral spine. Reasons of origin and clinical displays of disease are examined. The mechanism of medical influence of physical exercises and description of the motive modes is lighted up. Exercises are neat taking into account the period of disease, by the features of his flowing and functional state of patient. It is marked that the increasing trained provides an organism adaptation to loadings and results in liquidation of violations.

Previous work suggests females are evolutionarily adapted to have greater lumbar lordosis than males to aid in pregnancy load-bearing, but no consensus exists. To explore further sex-differences in the lumbar spine, and to understand contradictions in the literature, we conducted a cross-sectional retrospective study of sex-differences in lumbar spine morphology and sacral orientation. In addition, our sample includes data for separate standing and supine samples of males and females to examine potential sex-differences in postural loading on lumbosacral morphology. We measured sagittal lumbosacral morphology on 200 radiographs. Measurements include: lumbar angle (L1-S1), lumbar vertebral body and disc wedging angles, sacral slope and pelvic incidence. Lumbar angle, representative of lordotic curvature between L1 and S1, was 7.3° greater in females than males, when standing. There were no significant sex-differences in lumbar angle when supine. This difference in standing lumbar angle can be explained by greater lordotic wedging of the lumbar vertebrae (L1-L5) in females. Additionally, sacral slope was greater in females than males, when standing. There were no significant sex-differences in pelvic incidence. Our results support that females have greater lumbar lordosis than males when standing, but not when supine - suggesting a potentially greater range of motion in the female spine. Furthermore, sex-differences in the lumbar spine appear to be supported by postural differences in sacral-orientation and morphological differences in the vertebral body wedging. A better understanding of sex-differences in lumbosacral morphology may explain sex-differences in spinal conditions, as well as promote necessary sex-specific treatments. [ABSTRACT FROM AUTHOR]

A harmonic synergy between the load-bearing and stabilizing components of the spine is necessary to maintain its normal function. This study aimed to investigate the load-sharing along the ligamentous lumbosacral spine under sagittal loading. A 3D nonlinear detailed Finite Element (FE) model of lumbosacral spine with realistic geometry was developed and validated using wide range of numerical and experimental ( in-vivo and in-vitro ) data. The model was subjected to 500 N compressive Follower Load (FL) combined with 7.5 Nm flexion (FLX) or extension (EXT) moments. Load-sharing was expressed as percentage of total internal force/moment developed along the spine that each spinal component carried. These internal forces and moments were determined at the discs centres and included the applied load and the resisting forces in the ligaments and facet joints. The contribution of the facet joints and ligaments in supporting bending moments produced additional forces and moments in the discs. The intervertebral discs carried up to 81% and 68% of the total internal force in case of FL combined with FLX and EXT, respectively. The ligaments withstood up to 67% and 81% of the total internal moment in cases of FL combined with EXT and FLX, respectively. Contribution of the facet joints in resisting internal force and moment was noticeable at levels L4-S1 only particularly in case of FL combined with EXT and reached up 29% and 52% of the internal moment and force, respectively. This study demonstrated that spinal load-sharing depended on applied load and varied along the spine. [ABSTRACT FROM AUTHOR]

Purpose: The cortical bone trajectory (CBT) is a novel lumbar pedicle screw trajectory. The aim of this study was to conduct a detailed morphometric measurement of the lumbosacral spine for CBT pedicle screw, using the inferior facet of the cephalad level as a bony landmark.Methods: The three-dimensional computed tomography (3D-CT) scans of 86 adults who underwent examination of the lumbosacral spine were studied. The distances from the starting point to the inferior, lateral and medial border of the inferior facet of the cephalad level were measured. The angles formed between the screw trajectory and the sagittal plane, the superior endplate of the vertebral body and the posterior margin of the pars interarticularis were defined as the transverse angle (TA), cephalad angle 1 (CA1) and cephalad angle 2 (CA2), respectively.Results: The distances from the inferior border of inferior facet to the starting point from L1 to S1 were 8.9, 6.3, 4.1, 2.9, 1.4 and 0 mm, respectively. The distances from the medial border of the inferior facet to the starting point from L1 to S1 were between 3 and 4 mm. TA from L1 to S1 was 9.0°, 9.6°, 11.3°, 13.5°, 15.5°, and 8.2°, respectively. CA1/CA2 from L1 to S1 was 26.7°/38.7°, 26.0°/38.7°, 26.9°/38.0°, 24.4°/37.2°, 22.9°/35.1° and 18.4°/47.8°, respectively. The maximum screw diameters from L1 to S1 were 4.8, 5.1, 6.1, 6.8, 7.8, and 6.1 mm, respectively. Twenty-five millimeter can serve as a safe maximum length of CBT pedicle screws.Conclusions: The inferior facet of the cephalad level is an attractive bony landmark for establishing a starting point of CBT for minimally invasive spine surgery. [ABSTRACT FROM AUTHOR]

Purpose: The purpose was to investigate the median sacral artery (MSA) anatomical pathway in terms of its relationship to the lumbosacral spine.Methods: The posterior wall and lumbosacral spine of 54 adult embalmed cadavers were dissected. The MSA emerging point was identified. The distance from its emerging point to the lateral border of the vertebral body was measured bilaterally. The pathway of the MSA from the emerging point to the sacral promontory was described together with the MSA length. All outcomes were independently measured by two observers. Statistics on obtained data were calculated.Results: Most of the MSA emerging points were at the L5 vertebral body (94.4 %). The emerging point from the right and left lateral border of the L5 vertebral body was 3.31 ± 0.54 cm and 2.39 ± 0.51 cm, respectively. The MSA then lay along the middle one-third of the anterior surface of the lumbosacral junction. The mean length between the emerging point and the sacral promontory was 2.73 ± 0.97 cm.Conclusions: The MSA anatomy is important for prevention of intra-operative bleeding. For anterior lumbosacral surgery, the MSA should be identified and controlled before proceeding with the spinal surgery. For posterior bicortical sacral screw placement, the screw tip should be fluoroscopically checked to avoid inserting the screw tip into the mid sacral promontory. By first approaching the anterior sacral promontory, the surgeon will find the MSA within the middle one-third zone, and 2.47-2.99 cm cephalad to this, the iliac vessels. Knowledge of the MSA helps the surgeon to operate more safely. [ABSTRACT FROM AUTHOR]

Objective: To determine the position of the aortic bifurcation, angle of aortic-common iliac bifurcation in relation to the lumbar vertebra, diameter of distal aorta, length of common iliac, diameter of iliac at bifurcation in cadavers. Materials and Methods: The present study was done on 25 cadavers (16 males, 9 females) used for the dissection by 1st year MBBS students. The dissections were performed by anterior approach to the lumbar vertebra. The position of the aortic bifurcation, aortic bifurcation angle were measured in relation to lumbar vertebra. The remaining parameters were measured with the help of digital vernier caliper. Results: The aortic bifurcation was seen in between L3 and L5 vertebra in all the cases. In majority of cases, 16 (64%), the bifurcation was observed at the level of L4 vertebra. During statistical analysis, significant differences were observed in the mean values of aortic-iliac take off angles and in mean diameter of distal aorta. Conclusion: The exact location of aortic bifurcation is useful when invasive procedures are performed in the pelvis, laproscopic lumbar discectomy and lumbosacral total disc arthroplasty. The aortic bifurcation mostly found at the level of L4 vertebra in the present study similar to previous studies. The aortic bifurcation can be a reliable landmark for determining the lumbar vertebral segments on MRI or CT.

Introduction: The economical and social burden of degenerative disc disease remains unclear in Nepal due to lack of systematic data. However, considering the large volumes of spinal magnetic resonance imaging (MRI) performed for low back pain and/or radiculopathy, this has become the prime problems in all spinal care facilities in Nepal. Spinal MRIs constitute approximately sixty percent of the MRI performed in the Tribhuvan University Teaching Hospital (TUTH). This study is being conducted to review the pattern of degeneration of lumbosacral spine in patients referred for MRI at TUTH. Methods: A retrospective study was conducted at TUTH. Patients with low back pain and or radiculopathy undergoing MRI in the previous 5 months were included in the study. Patients with trauma and or conditions other than degenerative processes were excluded in the study. The findings were recorded and analyzed using SPSS. Results: A total of 301 patients were included in the study. Age ranged from 16 to 83 years, mean age being 42 years. Highest number of patients were in the 30-40 years age group (26.2%). Male to female ratio was 1.22. Disc bulge was the most common finding, seen in 77.7% followed by protrusion (58.5%), extrusion (3.9%) and sequestration (0.3%). Foraminal stenosis (68.4%) was the most common complication followed by central canal stenosis (51.8%) and nerve root compression (37.8%). Disc protrusion was the most significant (p<0.05) predictor of complications (nerve root compression, foraminal stenosis and central canal stenosis). Conclusion: The study shows that degenerative disc diseases remain the cause of morbidity in the most productive years of life (30-40 years of age). Large volumes of MRIs performed for this condition represent significant economic and healthcare burden in a developing country like Nepal as well. [ABSTRACT FROM AUTHOR]