Thoracic and lumbar spine

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Transpedicular screw fixation in the thoracic and lumbar spine with a novel cannulated polyaxial screw system

Transpedicular screw fixation in the thoracic and lumbar spine with a novel cannulated polyaxial screw system

of all cases (lumbar 9/246 = 3.7%, thoracic 2/80 = 2.5%). This may be caused by several factors: a) The middle and lower lumbar spine has been operated on with a higher frequency in this study (182/326 = 55.8% were placed in L3, L4 or L5). b) There were case specifi c factors such as traumatic and tumor lesions especially in the lower lumbar spine cases which increased this frequency. c) The screws used within the thoracic spine in general had a smaller diameter (5.5 mm) than in the lumbar spine (6.5 mm), and d) a more lateral approach was used in most of the thoracic spine cases when the surgeon was confronted with a rather narrow pedicle diameter. Complications which led to surgical revision occurred in only 3 cases with mis- placed screws ⬎ 4 mm (group D). Two patients presented with radicular pain corresponding to the misplaced screw and another patient developed CSF leakage from a dural tear close to the misplaced screw. However, the majority of group D screws, as well as all group C and B screws remained asymptomatic. Therefore, misplacement and complication rates of this cannulated screw series were within the range of navigation studies. The described tech- nique therefore seems to be feasible, for there are only a few possible pitfalls.

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A marker set for measuring the kinematics of the lumbar spine and thoracic spine during running : a technical note

A marker set for measuring the kinematics of the lumbar spine and thoracic spine during running : a technical note

Previous studies analysing the kinematics of the spine during running have tended to define either one or two rigid functional units: a lumbar segment (Schache et al., 2002) and a thoracic segment (Seay et al., 2011). Using this approach it has been possible to understand how spinal motion is coordinated with pelvic movement (Schache et al., 2002; Saunders et al., 2005; Seay et al., 2011). Studies investigating lumbar movement have used either a rigid wand, mounted over a single lumbar vertebrae, (Schache et al., 2002) or alternatively a set of skin-mounted makers placed across the lumbar region (Seay et al., 2008). In a recent paper, Kiernan et al. (2015) suggested that a skin-mounted makers reduce kinematic variability and may therefore be more appropriate when analysing fast movement, such as running. However, the skin-mounted marker set first proposed by Seay et al. (2008), involves the use of seven tracking markers placed across the lumbar spine. This configuration can be difficult to track continuously with a passive capture system. It is therefore it is necessary to understand whether a reduced set of four tracking markers could be used as an alternative to this seven-marker set.

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Reproducibility of kinematic measures of the thoracic spine, lumbar spine and pelvis during fast running

Reproducibility of kinematic measures of the thoracic spine, lumbar spine and pelvis during fast running

There  have  been  a  number  of  studies  investigating  the  kinematic  reliability  of  spinal  and  pelvic  motion  during  walking  [3,  4].  However,  although  a  few  authors  have  attempted  to  describe  pelvic/spinal  motion  during  running  [5‐7],  there  has  only  been  one  study  investigating  kinematic  reliability [8]. This study investigated the reproducibility of pelvic motion, using markers attached to  the anterior superior iliac spines (ASIS) and sacrum, and lumbar spine motion using a wand mounted  over the 12th thoracic spinous process. Although Schache et al. [8] were able to demonstrate good  reproducibility in most body planes, there  were  a number  of  limitations  to the study. Firstly, data  was collected during treadmill rather than over  ground running and participants ran at a relatively  slow speed of 3.9ms ‐1 . It is therefore not clear whether good reproducibility would be  obtained at  higher running speeds,  typical of elite distance runners. Secondly, although the marker wand gave  repeatable results  at  this slow  speed,  it  is  possible  that,  at higher  running  speeds, there  could  be  increased inertial motion leading to greater measurement variability. Finally, Schache et al. did not  include a thoracic segment in their kinematic protocol.  

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Determination of the human spine curve based on laser triangulation

Determination of the human spine curve based on laser triangulation

The main objective of the presented method was to provide a precise and automatic determination of the spatial curve of thoracic and lumbar spine based on the 3D shape measurement of the human torso. Three- dimensional measurements of the backs were performed using a 3D laser profilometer. Each measurement took approximately 10 seconds for 700 mm of longitudinal translation. After calibration, the single point measure- ment accuracy was 0.1 mm. Computer analysis of the measured surface returned two 3D curves. The first curve, the manual one, was determined by detecting the manual markings, the second, the automatic one, was determined by detecting surface curvature extremes.

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Age-related changes in muscle strength and spinal kyphosis angles in an elderly Japanese population

Age-related changes in muscle strength and spinal kyphosis angles in an elderly Japanese population

Abstract: Lumbar kyphosis and the decreased mobility of the lumbar spine increase the risk of falls and impair both the quality of life and the ability to perform activities of daily living. However, in the elderly Japanese population, little is known about the age-related changes and sex-related differences in muscle strength, including of the upper and lower extremities and back extensors. An adequate kyphotic or lordotic angle has also not been determined. In this study, we evaluated the age-related changes in muscle strength and spinal kyphosis in 252 males and 320 females $50 years of age. Grip, back extensor, hip flexor, and knee extensor strength; tho- racic and lumbar kyphosis; and spinal inclination in the neutral standing position were assessed, together with the range of motion of the thoracic and lumbar spine and spinal inclination. Grip strength, back extensor strength, and the strength of the hip flexors and knee extensors decreased significantly with aging, both in males (P,0.0001) and in females (P=0.0015 to P,0.0001). The lumbar but not the thoracic kyphosis angle decreased significantly with aging, only in females (P,0.0001). Spinal inclination increased significantly with aging in both males (P=0.002) and females (P,0.0001). Back extensor strength and the thoracic kyphosis angle were significant variables influencing the lumbar kyphosis angle in both sexes. Spinal inclination correlated significantly with both the lumbar kyphosis angle and hip flexor strength in males, as well as with the lumbar kyphosis angle in females.

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Inflammatory and structural changes in vertebral bodies and posterior elements of the spine in axial spondyloarthritis: construct validity, responsiveness and discriminatory ability of the anatomy based CANDEN scoring system in a randomised placebo contro

Inflammatory and structural changes in vertebral bodies and posterior elements of the spine in axial spondyloarthritis: construct validity, responsiveness and discriminatory ability of the anatomy based CANDEN scoring system in a randomised placebo controlled trial

(BME located between the corners of a vertebral body) are scored as 0 (absent), 2 (present); in DVUs in the thoracic and lumbar spine, a score of 2 is added for large non-corner lesions (≥25% of the height of the vertebral body, perpen- dicular to the endplate). It was decided to assign the score 2 for non-corner lesions, while 1 for corner lesions (both Figure 1 (A) User interface used for scoring of sagittal images according to the Canada-Denmark scoring system. Twenty- three discovertebral units (DVUs) are assessed. Fat lesions are scored in a similar way as inflammatory lesions, except that the posterior elements (FIL, SP, ST and TP/R) are not assessed for fat lesions. Fat lesions follow the principles of inflammation, except that posterior elements are not assessed. aCIL, anterior corner inflammatory lesion; NIL, non-corner inflammatory lesion; pCIL, posterior corner inflammatory lesion; FIL, facet joint inflammatory lesion; SP, spinous process inflammatory lesion; ST, soft tissue inflammatory lesion; aLIL, anterior lateral inflammatory lesion; pLIL, posterior lateral inflammatory lesion; TP/R, transverse process/rib; aCOBE, anterior corner bone erosion; pCOBE posterior corner bone erosion; NOBE, non-corner bone erosion; aCANK, anterior corner ankylosis; pCANK, posterior corner ankylosis; NANK, non-corner ankylosis; aCOS, anterior corner spur; pCOS, posterior corner spur; NOS, non-corner spur; FANK, facet joint ankylosis. (B) Axial view of inflammatory lesions. Note that as sagittal images are used for scoring, the boundaries illustrated in axial view may vary a few millimeters

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Earthquake related versus non earthquake related injuries in spinal injury patients: differentiation with multidetector computed tomography

Earthquake related versus non earthquake related injuries in spinal injury patients: differentiation with multidetector computed tomography

Data for each patient were entered into a Microsoft Excel database (Microsoft Corporation, Redmond, WA, USA). We performed data analysis on a personal com- puter using the SPSS statistical package (version 13.0 for Windows; SPSS Inc., Chicago, IL, USA). We determined the differences between the earthquake-exposed and non-earthquake-exposed cohorts using risk ratios (RRs) and the Mann-Whitney U test for gender, age (categor- ized as ages <35 years, 35-64 years and >64 years) and anatomic distribution of injury (categorized as cervical, thoracic and lumbar spine). Additionally, the anatomic distributions and types of injuries were compared using the c 2 test, and the patient ’ s age and spinal canal nar- rowing degrees were compared using the Mann-Whit- ney U test. The Kruskal-Wallis H test was performed to compare the spinal canal narrowing degrees between different AO types of injuries. We accepted two-tailed P values less than 0.05 as a statistically significant difference.

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Determination of thoracic and lumbar spinal processes by their percentage position between C7 and the PSIS level

Determination of thoracic and lumbar spinal processes by their percentage position between C7 and the PSIS level

Variations in the vertebral form may compromise the accuracy of our procedure. A recent study by Snider et al. has found no additional vertebrae and only 3 out of 60 LBP patients exhibited a sacralisation of L5 [24]. We observed no case where an additional vertebra was present or a vertebra was missing. Miscounting seems highly un- likely as an explanation for this, although a lumbarisation or sacralisation can’t be excluded. In future studies our results should be confirmed using image –guided criterion such as x-rays with opaque markers on the skin locate above spinal processes. The exact location on the spinal process should be determined in terms of its upper and lower boundaries, as we assume a spinal process can be as long as vertebral body height, which in turn has been measured between 14 and 23 mm in the thoracic, and 23 and 24 mm in the lumbar spine in mean [28,29].

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The association of lumbar curve magnitude and spinal range of motion in adolescent idiopathic scoliosis: a cross sectional study

The association of lumbar curve magnitude and spinal range of motion in adolescent idiopathic scoliosis: a cross sectional study

Results from this study showed that there was impair- ment in coronal, sagittal and axial ROM in the more severe curves (Group B), but the relationship between sagittal plane with lumbar curve magnitude was not statis- tically significant. This is particularly interesting consider- ing most of the movement in the sagittal plane is contributed by the lumbar spine as compared to the dominance of thoracic spine motion for the axial and cor- onal planes [11, 34]. Reason for this lack of sagittal signifi- cance can be two-fold. For one, we do not know the degree of exercise or activity level of the patient at the time of assessment, which may affect the ability of the patient to move the lumbar spinal segments. Secondly, the assessments were not performed at a standardized time and the mobility or flexibility of the spine may differ at different periods of the day [35]. Fortunately for our study population, we excluded all patients with thoracic deform- ity as these types of deformity may affect our ability to report coronal and axial plane ROM. It is thus reasonable to expect the flexibility of the spine to change throughout the day and it can also be manipulated with specific exer- cises that target lumbar ROM training. Whether specific exercises may improve spine ROM and delay degeneration requires further study.

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Potential risk factors and triggers for back pain in children and young adults. A scoping review, part II: unclear or mixed types of back pain

Potential risk factors and triggers for back pain in children and young adults. A scoping review, part II: unclear or mixed types of back pain

Methods: A scoping review design was selected to summarise the evidence, as there are many studies on “ risk factors ” for back pain. The scoping review followed the PRISMSA-ScR guidelines. We considered all studies that tested potential risk factors and triggers for thoracic and/or lumbar spine pain, in children, adolescents, and young adults ( ≤ 24 years). PubMed and Cochrane databases were searched from inception to September 2018, to identify relevant English language articles. The results regarding potential risk factors were separated into temporal precursors and bidirectional risk factors and the studies were classified by study design.

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Riding position and lumbar spine angle in recreational cyclists: a pilot study

Riding position and lumbar spine angle in recreational cyclists: a pilot study

In order to standardize the cyclists’ position during angle measurement, the cyclists’ hands were maintained on the handlebars in the riding position with both feet affixed to the cycle. The subject was asked to move their right leg until it was perpendicular to the floor and their right foot was parallel to the floor. Horizontal marks were then made on the subjects’ skin with a white board marker in the midline of the second sacral vertebrae (S2) and midline of the twelfth thoracic and first lumbar vertebrae (T12- L1). The inclinometer was zeroed against a vertical surface and recordings made at S2 and T12-L1 (9). This process was repeated and measurements recorded after 10 minutes of cycling in all three riding positions for each subject. Subjects were requested to stand and walk for three minutes between adopting each test cycling position.

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Imaging of diffuse idiopathic skeletal hyperostosis (DISH)

Imaging of diffuse idiopathic skeletal hyperostosis (DISH)

The upper lumbar segments are involved in a large percentage of cases. Radiographical abnormalities along the anterior aspect of the lumbar spine are similar to those of the cervical spine. Unlike the thoracic spine, the flowing ossifications are equally frequent on the right and left sides of the lumbar spine. One can observe ossi- fications of the spinous processes and of the interspinous ligaments. The narrowing of the intervertebral space is generally classified as mild to moderate. Degenerative changes in apophyseal joints can occur in the lower lumbar spine and in the lumbosacral junction too. Due to the hyperostosis, spinal stenosis is not rare. 5

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Clinical Reasoning: A man with rapidly ascending paralysis

Clinical Reasoning: A man with rapidly ascending paralysis

Patients with MOG-Abs, similar to our patient, tend to be male and to have improved response to treatment compared to those with AQP4-Abs. Though not true of this patient, 2 studies found that MOG-Ab patients often have bilateral ON as their initial symptom, while other studies reported that they were more likely to have a LEM involving the lumbar spine. The literature comparing AQP4-Ab and MOG-Ab patients is limited by small sample size, thus may lack the power to detect further differences between these 2 populations.

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The impact of sagittal balance on clinical results after posterior interbody fusion for patients with degenerative spondylolisthesis: A Pilot study

The impact of sagittal balance on clinical results after posterior interbody fusion for patients with degenerative spondylolisthesis: A Pilot study

between lumbar lordosis and improvements in VAS and ODI in patients whose postoperative pelvic tilt was not improved. By classifying patients according to an in improvement in pelvic tilt after operation demonstrated that pain and disability were greater in Group A than in Group B. Furthermore, patients in Group A had higher levels of self-reported pain and disability. In other words, patients with a non-improved PT postoperatively also had lower HRQOLs. In Group A, patients showed a tendency toward a poor clinical outcome. However, interestingly patients who presented with lower LL showed a better clinical outcome, and patients without lower LL in Group A experienced the highest levels of self reported pain and disability. On the other hand, in Group B, patients had better clinical outcomes regard- less of LL values and the other parameters.

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Role of Fluoroscopic Guided Percutaneous Transpedicular Biopsy in Diagnosing Spinal Pathologies

Role of Fluoroscopic Guided Percutaneous Transpedicular Biopsy in Diagnosing Spinal Pathologies

The skeletal system particularly the spine is the repository for metabolic, infectious and neoplastic disease. Patients with such involvement often present with roentgengraphically visible, but otherwise obscure lesions, Benign bone lesions sometimes resemble metastasis, metastasis lesion simulate infection and extensive metastasis may be seen in other bones with solitary lesions involving the spine.

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Application of two-parameter scoliometer values for predicting scoliotic Cobb angle

Application of two-parameter scoliometer values for predicting scoliotic Cobb angle

Although Adam’s forward bending test was previously useful for screening, the scoli- ometer can more precisely detect abnormality versus what appears to be normal during the forward bending test [24]. Literature reviews of vertebral rotation have confirmed the strong relationship between rib humps caused by vertebral rotation measured with a scoliometer and Cobb angle measured by standard posterior–anterior radiography [15]. It has been proven that the scoliometer is useful for indirectly calculating the Cobb angle through a specific formula. There have been two previous studies of mathemati- cal formulas of Cobb angle predictions by noninvasive parameters, such as scoliometer value and height [10, 11]. Korovessis et al. [10] published a study describing how to pre- dict scoliotic Cobb angle with one parameter using a scoliometer. The formulas were TC = 1.62 TI + 6.30 (TC = predicted thoracic angle, TI = apical thoracic scoliometer value) and LC = 1.58 LI + 7.36 (LC = predicated lumbar Cobb angle, LI = apical lumbar scoliometer value). The multi-regression relative values were 0.414 and 0.649, respec- tively. Sapkas et al. [11] reported a significantly strong correlation between scoliometer values and radiographic Cobb angles (r  = 0.685). However, statistical analysis showed that radiographically measured Cobb angle and scoliometer values were correlated with one another (r = 0.215), but not significantly. Coelho et al. also reported a one-param- eter formula and considered the correlation between scoliometer measurements and radiograph analysis to be good [23]. Table 1 shows the formulas and correlation values of the four studies compared with those of the current study.

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Progressive pseudorheumatoid dysplasia with new-found gene mutation of Wntl inducible signaling pathway protein 3

Progressive pseudorheumatoid dysplasia with new-found gene mutation of Wntl inducible signaling pathway protein 3

Clinical features of PPD are progressive and symmetrical swelling and deformation of multiple joints. As age in- creases, joints deform and pain aggravates gradually [3]. Patients with PPD have joint rigidity, limited activity and short stature, which severely affect their labor capacity and life quality. Patients with PPD also have spinal lesion, but no clinical appearance at early stage. Patients older than 15 years begin to have lumbar lordosis, thoracic ky- phosis, spinal scoliosis and bow-backed deformation [10].

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Patient demographics and MRI based measurements predict redundant nerve roots in lumbar spinal stenosis: a retrospective database cohort comparison

Patient demographics and MRI based measurements predict redundant nerve roots in lumbar spinal stenosis: a retrospective database cohort comparison

This is a retrospective database-based cohort comparison study. Reporting of the present study follows the STROBE Statement guidelines for reporting observational studies [10]. The inclusion criteria were symptomatic lumbar spinal canal stenosis requiring surgical decompression without fixation and availability of preoperative MRI that were performed in a scanner with at least 1.5 Tesla, in- cluding sagittal T1- and T2-weighted images and axial T2-weighted images in the picture archive and communi- cation system (PACS) of the institution. Exclusion criteria were previous history of lumbar spine surgery, lumbar de- formity as scoliosis or vertebral slip requiring fixation and congenital, traumatic, infectious or neoplastic diseases of the lumbar spine.

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Types and Prevalence of Coexisting Spine Lesions on Whole Spine Sagittal MR Images in Surgical Degenerative Spinal Diseases

Types and Prevalence of Coexisting Spine Lesions on Whole Spine Sagittal MR Images in Surgical Degenerative Spinal Diseases

3.2% of 230 patients who underwent surgery for spinal stenosis received both cervical and lumbar surgeries. In this study, WSST2I revealed a higher prevalence of MCSL than those from previous reports because we included not only the thoracic MCSL but also coexisting spine lesions that did not need surgical treatment but close observation. The surgical percentage of MCSL in our series is about 1.6% (5/306), which is similar to what has been previously reported. When considering that our surgical percentage means the rate of accompanying surgical lesions which were incidentally found at an exam, not identified by long- term follow up, 1.6% is not a low rate and has clinical signi- ficance to the patients. We assume that a long-term follow- up study for MCSL would show much higher surgical percentages compared to the pervious reports.

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Role of minimally invasive percutaneous fixation in thoracolumbar fractures: a prospective study

Role of minimally invasive percutaneous fixation in thoracolumbar fractures: a prospective study

of the suitable polyaxial driver into the assembly, this combined instrument was threaded into the screw head with rotation clockwise until it stopped. The screw shank should be aligned with the extended tabs, and the motion of the screw should be locked. The combined in- strument having the screw was guided over a guidewire till the pedicle and polyaxial screw was threaded into the pedicle. The guidewire was removed when the screw got through the pedicle and entered the body. While insert- ing the screw inside the pedicle, the markers were moni- tored on the guidewire for avoiding unintended displacement (Figs. 6, 7, and 8). After the insertion of the screw to the desired depth, the polyaxial driver was removed by moving the handle in a counterclockwise direction while extended tab assembly was firmly held. The polyaxial capability was verified by handling the screw extension. The length of each screw was set prop- erly, and that was verified with lateral fluoroscopy. The length of the rod was measured by reading it at the top of the caliper. Depending on the spine curvatures, the straight, lordosed, or kyphosed rod was selected. The rod holder was parallel to the skin surface, and the rod was perpendicular to the skin (parallel to the axis of the slots of extension). The rod was inserted in the cephalad slot of the extension and its tip put within the closed screw extension. The distal end of the rod was advanced straight down to be below the fascia and touch the top

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