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In 1961, K Merendino ‘in pure curiosity’, while tracking the murmur of mitral regurgitation, placed his stethoscope ‘on the vertex of the head’, and ultimately led to a medical curiosity and exam finding that not only bears his name, but awes medical learners at all stages of their careers. Merendino and colleagues collected seven such cases of the ‘Murmur on Top of the Head’ building on the work of others who provided a detailed description of mitral regurgitation and noted murmur radiation to the neck and cervical/lumbosacral spine. The majority of patients suffered from rheumatic heart disease or subacute bacterial endocarditis in native heart valves. Here, we report on a case of the ‘Murmur on Top of the Head’ and provide the reader/listener with a direct recording of the ‘Merendino murmur’ (as well as its spinal correlate) in an elderly woman with a bioprosthetic mitral valve.

Repetitive stress on the lumbosacral spine during sporting activity places the athletic patient at risk of developing symptomatic pars defect. Clinical history, physical examination, and diagnostic imaging are important to distinguish spondylolysis from other causes of lower back pain. Early pars stress reaction can be identified with advanced imaging, before the development of cortical fracture or vertebral slip progression to spondylolisthesis. Conservative management is first-line for low-grade injury with surgical intervention indicated for refractory symptoms, severe spondylolisthesis, or considerable neurologic deficit. Prompt diagnosis and management of spondylolysis leads to good outcomes and return to competition for most athletes.

Transpedicular fixation (TPF) as a method of posterior fusion is currently the most common, reliable and economically justified option of spinal fusion in various diseases and injuries of the lumbar spine, having more than half a century of history. As a result of the search for less invasive and more effective methods of fixation of the spinal segments to improve the results of surgical treatment, shorten the hospitalization, and reduce the number of perioperative complications, an approach involving fusion with rigid implant from the anterior (ALIF) was developed. Objective. To analyze the immediate and long-term results of treatment of single-level herniated discs by total removal of the intervertebral disc using anterior access with a rigid spondylodesis (ALIF) and the method of posterior discectomy, spondylodesis and transpedicular fixation (TPF). Materials and methods. A prospective cohort study was conducted. The study included patients after total intervertebral disc removal by the ALIF method and patients after discectomy and TPF. The achieved result was evaluated using radiological tests, as well as using standardized questionnaires and surveys. Results. After the surgery, patients in both groups showed a significant reduction in pain on the NRS scale. Patients from the first group had 4 to 0 for back and 8 to 0 for leg, patients from the second group had 6 to 4 for back and 8 to 0 for leg. The quality-of-life assessment by ODI scale also showed a positive trend from 36 to 4 in the first group and from 22 to 12 in the second group. Clinically, the result of surgical treatment was rated as excellent 5 in the ALIF group and as good in the TPF group 4 on the modified subjective assessment scale Macnab. Conclusion. The ALIF method as a decompression-stabilizing surgical aid is less traumatic. The less invasive nature of the technique was confirmed by significantly shorter surgical intervention time, smaller volume of intraoperative blood loss, and a shorter period of hospitalization. In the long-term period, statistically significant differences were obtained indicating that the ALIF method is more effective than TPF.

Background: The prevailing classification of whiplash associated disorder (WAD) focuses solely on neck injuries, thus implying that injuries to other spinal regions are relatively inconsequential. In fact, some whiplash studies exclude patients with injuries to lower spine. We examined whiplash pain locations of injured motorists and their statistical correlates. Method: De-identified archival data of 158 injured motorists (57 men and 101 women; mean age 39.4 years, SD=12.5) were reviewed statistically. Their motor vehicle accidents (MVAs) occurred 7 to 194 weeks previously (mean=50.7 weeks, SD=38.5), but all still experienced active whiplash symptoms requiring therapy. Results: The most frequently reported locations of whiplash pain were the head (89.9%), neck (88.6%), shoulders (80.4%), and lower back (77.8%). WAD studies that exclude patients with lower back pain might exclude about 82.9% of injured motorists: the remaining 17.1% of patients with whiplash injury only to the neck are presumably those less adversely affected by the MVA than patients with pain in multiple locations. No correlations of high or moderate magnitude were detected among the various pain locations. Furthermore, no high or moderate correlations were observed between clinical variables (including 2 neuropsychological symptoms scales) and reports of headache or pain in the neck or in lower back. Discussion and Conclusions: The prevailing WAD classification system needs to be renamed as specific to neck injury only: WAD-C. Parallel WAD classification systems need to be introduced separately for the lumbosacral spine (as WAD-LS) as well as the thoracic spine (as WAD-T) to improve diagnostic descriptive precision of clinical WAD assessments and of their research applications.

Sirenomelia is a rare, lethal congenital malformation of the fetus, typically characterized by the fusion of lower limbs and additional malformations involving the lumbosacral spine and urogenital and gastrointestinal tracts. We report a case of sirenomelia with anhydramnios detected during anomaly scan where the fetus had normal morphology of long bones of the lower limbs. There were associated abnormalities of the lumbosacral spine (caudal dysgenesis). The abortus had fused lower limbs, absent external genitalia and anal orifice, single umbilical artery, and Potter facies. We also highlight the interesting diagnostic challenges faced by us during this antenatal ultrasound. To our knowledge, this is the first case report of sirenomelia where the synchronous movement of lower limbs was a clue that led to the timely antenatal detection of this rare entity. This ultimately helped in perinatal counseling of parents to decide on termination of pregnancy.

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

Juvenile idiopathic arthritis (JIA) is a group of childhood inflammatory arthropathies that affects multiple joints including the spine, particularly the cervical region. There is paucity of literature regarding JIA in the lumbosacral spine; the few published studies which discuss imaging findings in the lumbosacral spine only include cohorts of older children and adolescents. We present a 22-month-old boy with refusal to walk, in which plain radiographs and contrast-enhanced magnetic resonance imaging of the lumbosacral spine suggested a diagnosis of JIA.

The literature review focuses on artificial intervertebral fusion. An increasing number of instrumented spinal procedures are performed each year with improved diagnostic and treatment strategies, advanced surgical technologies and optimal anesthetic techniques. One of the most common complications of spinal fusion is nonunion with the high reported incidence. Factors affecting fusion rates in lumbar spine surgery are described. Data from articles and textbooks of the last two decades have been used to reflect the current understanding of the research problem including reports in the earlier literature when appropriate.

This article reports on the case of a rare combination injury of a C3 pelvic ring fracture (Malgaigne's fracture) and simultaneous unstable traumatic spondylolisthesis (Meyerding grade 2) of the lumbosacral spine. The patient had pronounced neurological deficits of the lower extremities and tearing of the thecal sac. The selected primary and secondary surgical treatment algorithm of the polytraumatized patient as well as the course are described and critically discussed on the basis of the sparsely available literature.

Increased dural ectasia and vertebral thinning in the lumbosacral spine are common in Marfan syndrome. Dural ectasia is unchanged in middle-aged patients, who have stopped growing. Therefore, evaluation from childhood to adulthood is mandatory. Sixteen patients [four men and 12 women; mean age:17.7 (8.6-33.5) years] with dural ectasia at final follow-up [mean follow-up: 10.4 (5.0-16.7) years] were enrolled. Dural sac diameter (DD)/vertebral diameter (VD) were measured on MRI or CT images of midline sagittal slices at the level of dural ectasia between L5 and S3. The widest part of the dural sac was evaluated with Fattori grading: grade 0, normal; 1, mild; 2, moderate; and 3, severe dural ectasia. At final follow-up, dural ectasia was observed at L5 in 3, S1 in 9, S2 in 14, and S3 in 11 patients. Respective changes in DD/VD from primary to final follow-up were L5: 21.7-24.2 mm/29.1-27.9 mm; S1: 17.0-18.6 mm/21.0-19.5 mm; S2: 15.5-19.6 mm (P < 0.01)/9.6-7.5 mm; and S3: 15.6-17.9 mm (P < 0.05)/6.2-3.3 mm (P < 0.05). Four patients had grade 0 dural ectasia, seven had grade 1, two had grade 2, and three had grade 3. Grade was increased in nine patients with juvenile to young adult patients but did not with adults. During follow-up, dural ectasia size changed in the juvenile to young adult patients with Marfan syndrome, particularly at the S2-S3 level in our series.

Despite the fact that more and more guidelines that systematize our knowledge are being published, infective endocarditis remains a considerable diagnostic and therapeutic challenge. This is partially caused by the variable course of the disease process and numerous potential complications with high mortality. We present a case of a 48-year-old police officer with an inflammatory process within the aortic valve that led to the development of peripheral emboli in the central nervous system, kidney, spleen and within the lumbosacral spine. The complexity of the clinical situation required the cooperation of various medical specialists and combined use of various imaging methods, including ultrasound. This ultimately enabled the correct diagnosis to be established and had a significant impact on the planning and monitoring of the diagnostic process. Despite the fact that more and more guidelines that systematize our knowledge are being published, infective endocarditis remains a considerable diagnostic and therapeutic challenge. This is partially caused by the variable course of the disease process and numerous potential complications with high mortality. We present a case of a 48-year-old police officer with an inflammatory process within the aortic valve that led to the development of peripheral emboli in the central nervous system, kidney, spleen and within the lumbosacral spine. The complexity of the clinical situation required the cooperation of various medical specialists and combined use of various imaging methods, including ultrasound. This ultimately enabled the correct diagnosis to be established and had a significant impact on the planning and monitoring of the diagnostic process.

Back pain is a common disease and although it can be located in any of its cervical, thoracic and lumbosacral sections, however the vast majority of patients complain of lumbosacral pain. Back pain syndromes has become a challenge for modern rehabilitation, both in the issue of the prevention as well as therapy. A major problem for people with back pain is progressive disability, and thus a deterioration in the quality of life. Despite many treatment methods and health care resources devoted to back pain, disability and burden are increasing. An important place in the therapy of back pain syndromes is occupied by physical methods and health resort treatment. The work presents the use of balneotherapy and physiotherapy in the most common back pain syndromes, i.e. in chronic diseases of the intervertebral discs and degenerative changes of the lumbosacral spine.

Plain radiographs are an important tool for evaluation of the lumbosacral spine. Plain radiographs are routinely used as an initial diagnostic imaging modality and for postoperative surveillance. Initial evaluation using lumbosacral plain radiographs is most commonly to assess degenerative diseases, such as disc degeneration and/or spondylolisthesis. Postoperative plain radiographs can be used to assess fusion and adjacent segment degermation. The gold standard for evaluating overall sagittal and coronal balance is full-length plain radiographs, including the lumbosacral spine. Lumbosacral plain radiographs are also routinely used as an initial method of trauma evaluation to assess vertebral body compression and overall sagittal alignment.

A 60-year-old woman presented with a clinical picture consistent with multiple system atrophy of cerebellar type (MSA-C) and a 4-year history of involuntary movement. These movements consisted of painless semirhythmic, semicontinuous flexion and extension of the toes (Video). Nerve conduction studies and MRI scans of lumbosacral spine showed no abnormalities. Because the patient also had slight rigidity in her right arm, we obtained a DaTscan, which showed uptake reduction bilaterally with more reduction on the left side (Figure). We diagnosed her with painless legs and moving toes1,2 associated with MSA-C. The involuntary movements resolved with levodopa treatment.

Lumbo-sciatic pain is a symptom caused by a wide variety of processes that can be degenerative, inflammatory, infectious or tumor in nature...

Synovial chondromatosis is an uncommon benign neoplasm that usually affects large appendicular joints and only rarely the spine. There are only a few small series and case reports documenting malignant transformation of synovial chondromatosis into secondary chondrosarcoma, typically within the hip in the setting of recalcitrant disease and multiple recurrences. Chondrosarcoma arising in synovial chondromatosis of the spine is exceedingly rare, with only one previously published case report involving the craniocervical junction. We present a case of chondrosarcoma arising within synovial chondromatosis of the lumbosacral spine, with the diagnosis made at the time of initial presentation. We describe the clinical, imaging, and histopathological findings and review diagnostic criteria for this difficult diagnosis.

Background: Few series report on the management of high-grade spondylolisthesis (HGS) in adolescents and young adults. This review highlights a series of six consecutive cases with developmental (dysplastic) HGS successfully managed with L3 or L4 to S1 transpedicular screw placement, rather than in situ/noninstrumented lumbosacral fusion. Methods: The six patients with HGS, according to the Meyerding Grading, presented with low back pain and bilateral sciatica (2016–2020). Patients averaged 19.8 years of age and underwent posterior transpedicular L3 or L4-S1 screw fusions. They were all monitored for at least 6 postoperative months. Results: None of the six patients developed any major perioperative/postoperative complications; only one patient had severe postoperative back pain that slowly improved over 3 months. All the patients were clinically improved postoperatively, uniformly demonstrated fusion on postoperative CT studies, and considered the operation worthwhile. Conclusion: Posterior transpedicular screw fixation of the lumbosacral spine is an efficient and safe technique for the treatment of L3 or L4 to L5-S1 HGS. It is a suitable instrumented technique for managing adult/adolescent HGS and offers an alternative to the more typically performed in situ/noninstrumented L4-S1 procedures.

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.

Background Minimally-invasive spine procedures provide targeted, individualized diagnosis and pain management for patients. Competence in these procedures is acquired through experience and training. We created a 3D printed model of a degenerative lumbosacral spine with scoliosis and spondylosis, using materials that mimic bone and soft tissue density under CT. In this study, we evaluate the efficacy of using such a spine model to improve novice trainee confidence and proficiency in performing CT-guided facet joint injections. Results Thirteen medical students with no prior exposure to CT-guided spine procedures were divided into two groups. Both groups received an introductory didactic lecture, as well as identical pre- and post- test assessments. The Training group (7 students) received two separate training sessions using the simulation model. The Control group (6 students) received only one training session. The Training group demonstrated significantly fewer needle readjustments during the second simulation session, compared with the first session (p = 0.005). Both groups demonstrated significant increase in confidence in ability to perform CT-guided spine procedures on the post-test (p = 0.004 for the Control group and p = 0.00001 for the Training group). Conclusion A 3D printed lumbosacral spine phantom with realistic spondylosis can be made to facilitate novice training in minimally-invasive spine procedures. Training using a realistic lumbosacral spine model helps novices acquire the skills and confidence to perform CT-guided spine procedures.

Objective is to clarify the algorithm for diagnosis and prevention of treatment of purulent-inflammatory complications in patients after surgical treatment of diseases and injuries of the thoracic and lumbosacral spine. Materials and methods. For iterature analysis 55 sources were used, they were chosen in eLIBRARY.ru and PubMed. Search terms: thoracic and lumbosacral spine, purulent-inflammatory complications, spondylitis, spondylodiscitis, obesity, surgery stenosis of the spine. The article describes the risk factors, treatment and prevention of inflammatory complications in patients operated on for spinal injuries and diseases of the thoracic and lumbosacral spine. Conclusion. Despite the large number of publications, the influence of several factors on the development of inflammatory complications remains unclear: obesity, surgical treatment, the time of drainage of postoperative wounds, the impact of having a chronic illness. Requires refinement of the algorithm for diagnosis and prevention of treatment of purulent-inflammatory complications in patients after surgical treatment of diseases and injuries of the thoracic and lumbosacral spine.

Objective. To evaluate the influence of facet joint tropism on the formation of intervertebral disc hernias in the lumbosacral spine, and to determine the relationship between facet joint asymmetry and the type of hernia of the lumbar intervertebral discs. Material and Methods . Sixty-four patients aged 23–47 years with herniated lumbar intervertebral discs at one level (L 3 –L 4 , L4–L 5 or L 5 –S 1 ) were examined. Calculation of facet angles was performed on MRI axial slices. Tropism was verified when the difference between the angles of the right and left joints exceeded 10°. Results. When calculating the facet joint angles, tropism was detected in 22 (34.3 %) cases. One-factor analysis of the effect of facet joint tropism on the intervertebral disc hernia formation at all three levels revealed its significant influence (p = 0.0017; OR 7.416; 95 % CI 3.11–22.64). Analysis of the effect of facet joint tropism on the formation of intervertebral disc hernias at each level has shown that statistically significant effect is exerted only on L 5 –S 1 intervertebral discs (p = 0.0224; OR 13.537; 95 % CI 2.419–98.475). Conclusion. Facet joint tropism significantly influences the formation of intervertebral disc hernias at all three levels of the lumbosacral spine as a whole but does not affect the type of lumbar intervertebral disc hernia.

Objective: Comparative analysis of the results of microsurgical and endoscopic discectomy in patients with intervertebral hernias of the lumbosacral spine. Methods: The obtained results allows asserting that during performing operations on intervertebral hernias of the lumbosacral spine, endoscopic discectomy is more preferable. It has a positive effect on the result of the operation and the condition of the patient at the rehabilitation stage, and its effectiveness is not inferior to microsurgical discectomy. Results: In both groups, the deterioration of the general indicators of disease symptoms not marked. Patients operated by the microsurgical method had lower quality of life criteria than patients of the first group. Patients with endoscopic discectomy were quicker to recover activity, than in patients operated by the microsurgical method. Conclusion: The obtained results allows asserting that during performing operations on intervertebral hernias of the lumbosacral spine, endoscopic discectomy is more preferable. It has a positive effect on the result of the operation and the condition of the patient at the rehabilitation stage, and its effectiveness is not inferior to microsurgical discectomy. Keywords: Herniated disc, endoscopic micro-discectomy, endoscopic discectomy, lumbosacral spine.

Caudal Regression Syndrome (CRS) is a spectrum of congenital malformations, which consist of anomalies of the rectum, the urinary and genital systems, the lumbosacral spine, and the lower limbs. Though exact cause that leads to caudal regression syndrome is still unknown but it is believed that genetic influence as well as maternal pathologic factor related to carbohydrate metabolism plays an important role. The severity of morphologic disorder depends on residual spinal cord function. Infant may present with mild to severe neurological involvement with or without visceral anomaly. Here, we report a case of caudal regression syndrome in an 18 months old girl and presented with hypoplastic lower limb and bladder incontinence.Chatt Maa Shi Hosp Med Coll J; Vol.15 (2); Jul 2016; Page 57-60

Background Data: Pedicle screw instrumentation of the thoracolumbar and lumbosacral spine is a well-known technique used to achieve rigid fixation for a wide variety of spinal disorders. However, it is technically demanding and may be associated with potential operative risks and complications. Study Design: A retrospective clinical case study. Purpose: To determine the incidence of complications related to pedicle screw fixation of thoracolumbar and lumbosacral spine, and if it affects the final decision of the surgeons. Patients and Methods: The reported complications in 108 transpedicular thoracolumbar and lumbosacral fixation procedures were analyzed. All medical files, operative notes, and radiographs were examined. Results: Varied complications were observed in 35.2% of patients during and after surgery. General complications were found in 13.8%, most were trivial. Infection rate was 4.6%, all cured with antibiotics except one patient who required screws removal. Neurological complications were noted in 2.7% of patients. Transient root paresis developed in 1 patient due to pedicle wall perforation. Radicular pain was noted in one patient secondary to irritation from misplaced screw. Dural tears were reported in 0.9% of our patients during screws insertion. None of patients developed permanent deficit. Device-related complications occurred in 18.5% of patients, 55% of them occurred at thoracolumbar junction. Screw false passage was seen intra-operatively in 4.6%, pedicle fracture in 0.9%. Misplaced screw was reported in 5.5% and screw breakage in 3.7% of patients. Screw breakage occurred mainly in multi-level procedures which did not involve anterior column restoration (P

Magnetic resonance imaging (MRI) is commonly used to diagnose degenerative lumbosacral stenosis; however, studies show limited correlation between imaging and clinical signs. The purpose of this prospective observer agreement study was to use dynamic MRI of the lumbosacral (LS) spine of healthy dogs to determine reliable reference ranges. Twenty-two healthy large breed dogs were prospectively enrolled. MRI of the LS spine was performed in T2-weighted, T1-weighted, and T2-weighted SPACE sequences in neutral, flexed, and extended positions. Four observers performed image analyses. Measurements included LS angle, vertebral canal height and area, and LS foraminal areas. Ordinal categorical assessment of loss of fat signal in the foramina, LS compression, intervertebral disc (IVD) degeneration, spondylosis, and IVD protrusion was also performed. The majority of values were significantly larger in flexion versus neutral position, and significantly smaller in extension versus neutral position (P .05). Subclinical compression and IVD protrusion was noted in a neutral position in 45% and 55% of dogs and in an extended position in 85% and 73% of dogs, respectively. Interobserver agreement was strong (intracluster correlation coefficient [ICC] .5) except for the L7:LS vertebral canal area ratio (ICC ≤ .03). Intraobserver agreement was high (rho .5) for all measurements except for the mid-L6:LS vertebral canal height ratio (rho = .38). There was poor interobserver agreement for loss of fat signal in the foramina and evidence of compression. This study provides the groundwork for future studies using dynamic MRI to evaluate dogs with signs of clinical LS disease.

Background To quantify the dosimetric parameters of different bone marrow sparing strategies and to determine the optimal strategy for cervical cancer patients undergoing postoperative intensity-modulated radiotherapy (IMRT). Methods Fifteen patients with cervical cancer were selected for analysis. The planning target volume (PTV) and the organs at risks (OAR) including small bowel, bladder, rectum, femoral heads, os coxae (OC), lumbosacral spine (LS) and bone marrow (BM) were contoured. For each patient, four IMRT plans with different strategies were generated, including one plan without BM as the dose-volume constraint, namely IMRT (N) plan, and three bone marrow sparing (BMS-IMRT) plans. The three BMS-IMRT plans used the BM, OC, OC and LS respectively, as the BM OAR, namely as IMRT (BM), IMRT (OC) and IMRT (OC + LS) plans. Dose volumes for the target and the OARs were compared using analysis of variance (ANOVA). Results Compared with IMRT (N) plans, the dose to the small bowel, bladder, rectum and femoral heads showed no increase in the three BMS-IMRT plans. However, the irradiated dose to BM, OC and LS significantly decreased. In particular, the mean dose of BM, OC and LS decreased by about 5Gy (p

Purpose Dermal sinus tract (DST) is a challenging clinical diagnosis in children. The purpose of our study was to analyze the added value of magnetic resonance imaging (MRI) in the diagnosis of DST involving the lumbosacral spine. We also sought to establish an MRI-based scoring system to simplify the diagnosis of DST. Methods MRI images of 20 patients with clinically suspected DST were retrospectively assessed by two neuroradiologists blinded to the surgical results. The MRI studies were performed from July 2003 to July 2013. Institutional Review Board (IRB) approval was obtained. All MRI studies were assessed with respect to five imaging signs: A) visualization on both sagittal and axial images, B) dural penetration, C) associated tethered cord, D) presence of tumor or inflammation, and E) attachment to conus medullaris. The frequency of each imaging sign in the study population was calculated. For the 20 patients who underwent surgery, sensitivity and specificity of each neuroradiologist’s interpretation of the MRI data were calculated using operative findings as the gold standard. Results Twelve of the 20 had confirmed DSTs. The incidences of the five imaging signs were as follows: A) visualization on both sagittal and axial images (12/12, 100%), B) dural penetration (10/12, 83.3%), C) associated tethered cord (7/12, 58.3%), D) presence of tumor or inflammation (4/12, 33.3%), and E) attachment to the conus medullaris (4/12, 33.3%). The best combination of findings predictive of DST was simply the appearance of DST on both axial and sagittal imaging, which resulted in a sensitivity of 100% and a specificity of 75-100%. Conclusion Visualization of DST on both axial and sagittal imaging is the best marker for pathology proven DST. Using a higher threshold score on the five-point scoring system that we proposed did not increase sensitivity or specificity in the diagnosis of DST; however, it may still prove clinically helpful in standardizing reporting leading to a more accurate and detailed assessment.

Conducted electrical weapons are designed to cause temporary electro-muscular incapacitation (EMI) without significant injury. The objective of this study was to assess the risk and cause of spinal injury due to exposure to a benchtop EMI device. Porcine subjects were exposed to 19 and 40 Hz electrical stimuli for a prolonged duration of 30 sec. X-ray imaging, necropsy, and accelerometry found that lumbosacral spinal fractures occurred in at least 89% of all subjects, regardless of the stimulus group, and were likely caused by musculoskeletal fatigue-related stress in the lumbosacral spine. Spinal fractures occurred in the porcine model at an unusually high rate compared to human. This may be due to both the prolonged duration of electrical stimulation and significant musculoskeletal differences between humans and pigs, which suggests that the porcine model is not a good model of EMI-induced spinal fracture in humans.

Spinal arteriovenous malformations (SAVMs) are rare vascular lesions and account for about 4% of primary intraspinal masses. Since SAVMs can involve any location along the spinal column and produce a host of different problems, the symptoms are extremely variable. There are few reports of simultaneous cerebral SAH and intraventricular hemorrhage (IVH) following rupture of a spinal AVM (SAVMs). Herein, we present a rare case of Lumbo Sacral spine arteriovenous malformation, which clinically manifests as sudden onset of severe headache and vomiting due to isolated fourth ventricle Hemorrhage (IVH) without cerebral subarachnoid hemorrhage.

A 29-year-old female with a history of nonischemic cardiomyopathy and lumbosacral spine surgery presents for Cesarean section. A carefully titrated continuous lumbar epidural was used as the primary anesthetic with an intrathecal injection of fentanyl to augment the block. Ultrasound guidance was used to facilitate placement of the epidural catheter given the patient’s history of lumbosacral spine surgery.

Cutaneous birthmarks are usually innocuous. However, when over the lumbosacral spine, especially, in the midline, the likelihood of an associated underlying spinal dysraphism rises. Herein, we discuss the various cutaneous markers and their associated occult spinal dysraphisms.

BACKGROUND Due to the location and high dose required for disease control, pediatric chordomas are theoretically well-suited for treatment with proton therapy, but their low incidence limits the clinical outcome data available in the literature. METHODS AND MATERIALS: Between 2008 and 2019, 29 patients with a median age of 14.8 years (range, 3.8–21.8) received proton therapy for non-metastatic chordoma at a single institution. Twenty-four tumors arose in the clivus/cervical spine region and 5 in the lumbosacral spine. Twenty-six tumors demonstrated well-differentiated histology and 3 were dedifferentiated or not otherwise specified (NOS). Approximately half of the tumors underwent specialized testing: 14 were brachyury-positive and 10 retained INI-1. Seventeen patients had gross disease at the time of radiation. The median radiation dose was 73.8 GyRBE. RESULTS With a median follow-up of 4.3 years (range, 1.0–10.7), the 5-year estimates of local control, progression-free survival, and overall survival rates were 85%, 82%, and 86%, respectively. Excluding 3 patients with dedifferentiated/NOS chordoma, the 5-year local control, progression-free survival, and overall survival rates were 92%, 92%, and 91%, respectively. Serious toxicities included 3 patients with hardware failure or related infection requiring revision surgery, 2 patients with hormone deficiency, and 2 patients with Eustachian tube dysfunction causing chronic otitis media. CONCLUSION In pediatric patients with chordoma, proton therapy is associated with a low risk of serious toxicity and high efficacy, particularly in well-differentiated tumors. Complete resection may be unnecessary for local control and destabilizing operations requiring instrumentation may result in additional complications following therapy.

Lumbo-sacral fractures are complex injuries that often occur alongside pelvic ring trauma. They are often missed on initial assessment and plain radiography, and delayed treatment can lead to pain, reduced mobility and neurological compromise. Careful clinical examination is essential and identification of the fracture pattern often requires CT imaging. A large number of classification systems are available to help guide decision-making and these have recently been summarised in the comprehensive AO Spine sacral fracture classification system. Surgical intervention includes both neurological decompression and stabilisation and is indicated for patients with neurological compromise, lumbo-sacral instability and significant soft tissue injuries.

Lumbar spondylolisthesis presents a formidable challenge to the complex biomechanical properties inherent to this region of the spine. Anatomical malalignment of the lumbar spine in the sagittal plane secondary to spondylolisthesis alters both the kinematic and load distribution patterns in the three predominant loading classifications, resulting in a pathomechanical response of the lumbopelvic spine and global sagittal balance. From a biomechanical standpoint, the mechanisms of injury and grade of spondylolisthesis affect the three longitudinal columns of spinal stability, degenerative processes of the three-joint-complex, and efficiency of the lumbosacral spine to optimally transmit load and motions in the axial skeleton.

Purpose: to evaluate the effectiveness of the program of physical rehabilitation on the basis of studying the dynamics of indicators of empirical research, vertebro-neurological symptoms and biogeometric profile in wrestlers– veterans of sports with osteochondrosis of the lumbosacral spine. Material & Methods: theoretical analysis and generalization of literature data; use of diagnostic scales (visual analogue pain scale (VAS), scale of five-point evaluation of vertebro-neurological symptoms), determination of mobility of the lumbosacral spine, Schober's test, Tommyer test– fingers-floor test; methods of mathematical statistics. Results: based on the results of the study, a statistically significant dynamics of the parameters of the empirical study, the parameters of the biogeometric profile in the wrestlers– the veterans of the main group sport, was found in the course of physical rehabilitation according to the developed program with the application of therapeutic gymnastics, exercises in post-isometric relaxation. Conclusion: the results of the study confirmed the effectiveness of the comprehensive physical rehabilitation program developed by us, showed that a positive effect on the index of pain, vertebro-neurological symptoms, an increase in the amplitude of the spinal motion in both the sagittal and frontal planes.

Most ancient people thought that painful diseases like sciatica resulted from evil spirits that invaded the body through the “sinister” left nostril or left ear producing pain by infiltrating the blood vessels and heart. Of the many Egyptian gods Sekhmet and Seth were most commonly associated sciatica. The sudden violent sharp pain of sciatica was called the witch’s shot in Germany and in England, the elf’s arrow. Around the fifth century B.C., Hippocrates and his fellow Greek physicians challenged the notion that diseases resulted from supernatural forces. Hippocrates felt that sciatica resulted from damage to the hip. He observed that it was particularly common during summer and autumn and he speculated that hot weather led to drying up of the joint fluid. From what we know today, this seasonal occurrence was probably due to injuries from increased physical activities such as farming and athletic events common at that time of the year.

TW niniejszym opracowaniu zwrócono uwagę na występowanie dolegliwości bólowych odcinka lędźwiowo-krzyżowego u pracowników szczecińskich uczelni, będących pacjentami Poradni Fizjoterapii w Samodzielnym Publicznym Zakładzie Opieki Zdrowotnej Szkół Wyższych w Szczecinie. Przedstawiono zagadnienia dotyczące anatomii funkcjonalnej, patomechanizmu powstawania bólu tego odcinka kręgosłupa oraz diagnostyki i wybieranych form leczenia, ze zwróceniem szczególnej uwagi na zabiegi fizjoterapeutyczne. Zagadnienia te stanowią wprowadzenie do cyklu doniesień, które zostały opracowane na podstawie wyników uzyskanych podczas 2-letnich badań prowadzonych wśród pracowników szczecińskich szkół wyższych, u których zdiagnozowano zmiany w obrębie dolnego odcinka kręgosłupa. W przeprowadzonych badaniach zwrócono uwagę na następujące zaburzenia: zmiany krzywizny lędźwiowej (opublikowane w Pomeranian Journal of Life Sciences), zaburzenia ze strony stawów krzyżowo-biodrowych, zmiany zwyrodnieniowe, uszkodzenia krążka międzykręgowego, zespół mięśnia gruszkowatego oraz otyłość – które zostaną szczegółowo przedstawione w kolejnych doniesieniach.

Although Tarlov cysts (TC) were first described in 1938, our understanding of these common spinal lesions remains poor. As TCs represent incidental findings in the vast majority of cases, evidence to guide their management is limited to small case series. When they are symptomatic, the presentation can have significant overlap with degenerative spine disease. This is the first report demonstrating growth of TCs. The patient underwent open surgical reduction of the symptomatic TCs, leading to improvement in her symptoms.

Purpose: t o establish the effect of a comprehensive program of physical rehabilitation on the quality of life of wrestlers – veterans of sports with osteochondrosis of the lumbosacral spine in the training motor regime. Material & Methods: 34 athletes-veterans at the age of 36–45 years, a kind of struggle – judo and sambo-wrestling took part in the study. Sports qualification of athletes: MS – 25 people, MSIG – 9 people. The test was carried out on the verbal assessment scale of pain, the degree of vertebro-neurological disorders was assessed, the standard of living for the Oswestrovsky questionnaire was determined. Result s: after application of the proposed comprehensive physical rehabilitation program for wrestlers – veterans of sports of the MG in 68% of cases, complaints were absent, the degree of vertebro-neurological disorders decreased, the results of the questionnaire on the Oswestrovsky questionnaire showed a statistically significant decrease in complaints of pain in various spheres of life. Conclusion: the positive influence of the developed program of physical rehabilitation on the quality of life of wrestlers – veterans of sports are proved.

Male patient, 35 years old, with occasional mild intensity back pain. Lumbosacral spine radiography showed bone structure with increased density, diffusely and symmetrically, conferring to the vertebral bodies “bone-within-bone” aspect, suggesting osteopetrosis (OP). Whole-body bone scintigraphy showed abnormal uptake in proximal epiphysis of both the humeri, tibias and fibulas, distal epiphysis of the femurs and focal in the ribs suggesting old fractures. Conclusions: Nuclear Medicine may provide an important contribution as supporting diagnosis and extensive skeletal evaluation such as fractures and infection. Bone scintigraphy might also be used for baseline assessments, allowing longitudinal monitoring of the disease and patient follow-up.

The patient was a 13-year-old boy who complained of pain in both buttocks. Plain and reconstructive computed tomography (CT) images showed an ossified lesion within the dura mater at the L5–S2 levels, and arachnoiditis ossificans in the lumbosacral area was suspected. In the operative findings obtained after cutting the dura, a bone fragment 4.5 × 0.5 × 0.5 cm in size was observed in the center of the strongly adhesive nerve bundle of the cauda equina, which was removed en bloc. The postoperative clinical course of the patient was excellent. The case, along with a review of literature is presented.

Wstęp: Bóle dolnego odcinka kręgosłupa dotyczą większości kobiet w ciąży. Na skutek dolegliwości bólowych często pojawiają się ograniczenia funkcjonalne różnego stopnia sprawiające kłopot przy wykonywaniu wielu codziennych czynności. Celem pracy była ocena stopnia dolegliwości bólowych odcinka lędźwiowo-krzyżowego kręgosłupa oraz określenie zależności badanych ograniczeń od zmiennych kontrolowanych.Materiał i metody: Badanie przeprowadzono na terenie miasta Szczecina wśród 81 kobiet ciężarnych. Posłużono się standaryzowanym kwestionariuszem ankiety Oswestry (The Oswestry Low Back Pain Disability Questionnaire). Do weryfikacji statystycznej otrzymanych wyników badań wykorzystano test niezależności χ². Przyjęto poziom istotności p < 0,05.Wyniki: U większości kobiet będących po raz drugi w ciąży (n = 38) stwierdzono mierną niepełnosprawność. Zależność pomiędzy stopniem niepełnosprawności a kolejnością ciąż była statystycznie istotna (χ² = 40,457; p = 0,0000000085).Wnioski: U większości kobiet ciężarnych zaobserwowano ograniczenia funkcjonalne spowodowane dolegliwościami bólowymi odcinka lędźwiowo-krzyżowego kręgosłupa w stopnie miernym. Stopień ograniczeń funkcjonalnych zależny jest od trymestru ciąży i kolejności ciąż.

Posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), and anterior lumbar interbody fusion (ALIF) are some of the most commonly used approaches for fusion of the lumbosacral spine. All of these approaches have certain pitfalls that make them less suitable in certain cases. The trans-sacral approach utilizes a pre-sacral corridor to gain access to the L5–S1 disc space. It offers some advantages over other MIS techniques by reducing disruption of the musculature and minimizing injury to vital neurovascular, abdominal, and pelvic structures. Preservation of the annulus and the anterior longitudinal ligament increases implant and biomechanical stability. Overall, the trans-sacral approach has demonstrated high fusion rates, significant improvement in pain and function, low complication rates, and shorter hospital stays.

Objectives To evaluate the relationship between lumbosacral morphological parameters and intervertebral disc degenerative disease. Material and methods A retrospective study of MRI lumbosacral studies of low backache patients included 152 patients (92 females and 60 males). Patients were evaluated for the presence of disc herniation or degeneration. Angles of lumbar lordosis, sacral table, and sacral kyphosis were measured. Results Normal population included 51 patients (30 males and 21 females) and showed no statistically significant difference between male and female. 101 patients had degenerated disc and/or disc herniation. There was no statistically significant difference between normal population and patients with disc pathology as regards lumber lordosis angle (p > 0.05) while a statistically significant difference was observed as regards both sacral kyphosis angle and sacral table angle. Patients with disc pathology showed; moderate negative correlation between lumber lordosis angle and sacral table angle (p = 0.001), strong negative correlation between lumber lordosis angle and sacral kyphosis angle (p = 0.000) and no correlation between sacral table angle and sacral kyphosis angle (p > 0.05). Conclusion The risk of developing disc degeneration and herniation increases with increasing sacral table angles and decreasing sacral kyphosis angle.