-
Taiwanese Journal of Obstetrics &... Jul 2021Spina bifida (SB) is a congenital birth defect defined as a failure of the neural tube formation during the embryonic development phase. Fetoscopic repair of SB is a... (Review)
Review
OBJECTIVE
Spina bifida (SB) is a congenital birth defect defined as a failure of the neural tube formation during the embryonic development phase. Fetoscopic repair of SB is a novel treatment technique that allows to close spinal defect early and prevent potential neurological and psychomotor complications.
CASE REPORT
We present a case report of a 32-year-old-multigravida whose fetus was diagnosed with lumbosacral myelomeningocele at 23rd week. Fetoscopic closure of MMC was performed at 26 weeks. At 32 weeks, due to premature amniorrhexis and placental abruption, an emergency C-section was performed. Newborn's psychomotor development was within normal limits.
CONCLUSION
Although intrauterine treatment has an increased risk of premature labor, placental abruption, prenatal closure is associated with improved postnatal psychomotor development. Prenatal surgery decreases the risk of Arnold-Chiari II malformation development and walking disability. Fetoscopic closure of SB is becoming a choice for treatment with beneficial outcomes for mother and fetus.
Topics: Abruptio Placentae; Adult; Cesarean Section; Female; Fetal Membranes, Premature Rupture; Fetoscopy; Humans; Infant, Newborn; Lumbosacral Region; Meningomyelocele; Pregnancy; Pregnancy Trimester, Second; Spinal Dysraphism
PubMed: 34247822
DOI: 10.1016/j.tjog.2021.05.032 -
Acta Orthopaedica Et Traumatologica... 2016The aim of this study was to analyze the relationship, if any, between lumbar disc herniation and lumbosacral morphology.
OBJECTIVE
The aim of this study was to analyze the relationship, if any, between lumbar disc herniation and lumbosacral morphology.
METHODS
Intervertebral disc angles (IDA), lumbar lordosis angle (LLA), lumbosacral lordosis angle (LSLA), lumbosacral angle (LSA), and sacral tilt (ST) were measured on lumbar magnetic resonance imaging of 224 patients with LDH (n=151) and without LDH (n=73) and were then compared.
RESULTS
Regarding LLA, LSLA, LSA and ST, there were no significant differences between the 2 groups. The smallest IDA of each level (except L2-L3) was detected at the same level with disc herniation. When the relationship between the grade of disc herniation and IDA was evaluated in patients with LDH, angles of L3-L4 and L4-L5 levels were significantly smaller in patients with extruded disc herniation (p=0.009 and p=0.013, respectively).
CONCLUSION
Despite changes in IDA by grade and level of disc herniation, no relation was found between lumbosacral alignment and LDH.
Topics: Adult; Aged; Animals; Female; Humans; Intervertebral Disc; Intervertebral Disc Displacement; Lordosis; Lumbar Vertebrae; Lumbosacral Region; Magnetic Resonance Imaging; Male; Middle Aged; Turkey; Young Adult
PubMed: 27130392
DOI: 10.3944/AOTT.2016.14.0278 -
Medical Ultrasonography Feb 2018Patients with low back pain (LBP) frequently undergo various imaging studies in the pursuit of a more precise diagnosis. Ultrasound (US) has the advantage of being a... (Review)
Review
Patients with low back pain (LBP) frequently undergo various imaging studies in the pursuit of a more precise diagnosis. Ultrasound (US) has the advantage of being a widely available, multiplanar, fast and radiation-free diagnostic tool. Moreover, compared to most of the other imaging modalities, it is particularly efficient in the visualization and assessment of soft tissues. Consequently, the question about the possible diagnostic application of US in such a common pathology as LBP is very relevant to the clinical practice. For this reason, we performed a review of the literature on the diagnostic value of US in differentconditions that could cause LBP. We hereby discuss available studies on the diagnostic application of US in spinal canal stenosis and disc herniation (probably of historical significance only), as well as in the pathology of soft tissue structures like the lumbar and pelvic ligaments, muscles and entheses, the thoracolumbar fascia and the sacroiliac joints (maybe of greater importance nowadays). The evidence for the diagnostic value of US is not equivocal, though promising for some of the causative conditions, and clearly this area remains open to further research.
Topics: Back Muscles; Humans; Ligaments, Articular; Low Back Pain; Lumbosacral Region; Spinal Diseases; Ultrasonography
PubMed: 29400373
DOI: 10.11152/mu-1245 -
Translocation of the conus medullaris during dynamic lumbosacral magnetic resonance imaging in dogs.American Journal of Veterinary Research Jul 2021To investigate the change in the lumbosacral angle (ΔLSA) and conus medullaris (CM) displacement in healthy dogs undergoing dynamic MRI with changes in the posture of...
OBJECTIVE
To investigate the change in the lumbosacral angle (ΔLSA) and conus medullaris (CM) displacement in healthy dogs undergoing dynamic MRI with changes in the posture of their pelvic limbs from neutral posture to flexion or extension posture and to evaluate for potential correlation between ΔLSA and CM displacement.
ANIMALS
9 healthy adult Beagles.
PROCEDURES
Dogs underwent dynamic MRI with their pelvic limbs positioned in neutral, flexion, and extension postures. From T2-weighted sagittal midline plane MRI images, 2 observers measured the lumbosacral angle and CM location in duplicate for each posture for each dog. Intra- and interobserver agreement was assessed, and the Spearman rank correlation coefficient (ρ) was used to assess for potential correlation between ΔLSA and CM displacement for changes in pelvic limb posture from neutral to flexion or extension.
RESULTS
Overall, the mean ΔLSA and CM displacement for changes in posture were 23° and 9.09 mm (caudal displacement) for the change from neutral to flexion posture, 8.4° and -2.5 mm (cranial displacement) for the change from neutral to extension posture, and 32.2° and 11.64 mm (caudal displacement) for the change from extension to flexion posture. The ΔLSA strongly correlated (ρ = 0.705; 95% CI, 0.434 to 0.859) with displacement of the CM.
CONCLUSIONS AND CLINICAL RELEVANCE
The use of dynamic MRI, compared with conventional MRI, will better help to characterize clinically normal and abnormal features of the lumbosacral region of the vertebral column and associated spinal cord during postural changes. Further, when limited translocation of the CM is evident on dynamic MRI, veterinarians should suspect underlying lumbosacral pathophysiologic processes or anatomic abnormalities.
Topics: Animals; Dogs; Lumbosacral Region; Magnetic Resonance Imaging; Posture; Spinal Cord; Spine
PubMed: 34166091
DOI: 10.2460/ajvr.82.7.554 -
Neurology India 2023
Topics: Humans; Bronchogenic Cyst; Spinal Cord Compression; Lumbosacral Region; Magnetic Resonance Imaging; Spinal Cord Neoplasms
PubMed: 38174506
DOI: 10.4103/0028-3886.391370 -
Brazilian Journal of Physical Therapy 2021There is considerable overlap between pain referral patterns from the lumbar disc, lumbar facets, the sacroiliac joint (SIJ), and the hip. Additionally, sciatic like... (Review)
Review
BACKGROUND
There is considerable overlap between pain referral patterns from the lumbar disc, lumbar facets, the sacroiliac joint (SIJ), and the hip. Additionally, sciatic like symptoms may originate from the lumbar spine or secondary to extra-spinal sources such as deep gluteal syndrome (GPS). Given that there are several overlapping potential anatomic sources of symptoms that may be synchronous in patients who have low back pain (LBP), it may not be realistic that a linear deductive approach can be used to establish a diagnosis and direct treatment in this group of patients.
OBJECTIVE
The objective of this theoretical clinical reasoning model is to provide a framework to help clinicians integrate linear and non-linear clinical reasoning approaches to minimize clinical reasoning errors related to logically fallacious thinking and cognitive biases.
METHODS
This masterclass proposes a hypothesis-driven and probabilistic approach that uses clinical reasoning for managing LBP that seeks to eliminate the challenges related to using any single diagnostic paradigm.
CONCLUSIONS
This model integrates the why (mechanism of primary symptoms), where (location of the primary driver of symptoms), and how (impact of mechanical input and how it may or may not modulate the patient's primary complaint). The integration of these components individually, in serial, or simultaneously may help to develop clinical reasoning through reflection on and in action. A better understanding of what these concepts are and how they are related through the proposed model may help to improve the clinical conversation, academic application of clinical reasoning, and clinical outcomes.
Topics: Clinical Reasoning; Humans; Low Back Pain; Lumbosacral Region; Sacroiliac Joint
PubMed: 33371952
DOI: 10.1016/j.bjpt.2020.12.001 -
Journal of the American Association For... Jan 2020Epidural puncture in swine is technically challenging. Several combinations of limb and body positions have been suggested to increase lumbosacral interlaminar space...
Epidural puncture in swine is technically challenging. Several combinations of limb and body positions have been suggested to increase lumbosacral interlaminar space (LSS) and lumbosacral angle (LSA). This study investigated whether cranial hyperflexion of pelvic limbs increased LSS and LSA in laterally and sternally recumbent juvenile Duroc and adult Yucatan pigs and assessed which position produced the largest LSS. Juvenile Duroc ( = 7) and adult Yucatan ( = 7) pigs were euthanized and randomly placed in 4 positions: sternal with neutral limbs, sternal with cranially hyperflexed limbs, lateral with neutral limbs, and lateral with hyperflexed limbs. LSS and LSA were measured on transverse axial CT images of the spine and compared by using multivariate ANOVA and the Student test. In both age groups, LSS was greater in lateral flexed (juvenile, 7.0 ± 0.7 mm; adult, 15.9 ± 1.1 mm) and sternal flexed (juvenile, 7.5 ± 1 mm; adult, 17.1 ± 1.1 mm) positions than in lateral neutral (juvenile, 5.4 ± 0.9 mm; adult, 9.6 ± 1.6 mm) position. In addition, in both age groups, LSS and LSA in lateral neutral position were smaller than lateral flexed, sternal neutral, and sternal flexed positions. In adults, LSS was greater in lateral flexed and sternal flexed than in sternal neutral position. Hyperflexion of pelvic limbs increases LSS and LSA in sternally recumbent adult Yucatan pigs and laterally recumbent adult Yucatan and juvenile Duroc swine. Increased LSS from positioning pigs with pelvic limbs flexed in sternal or lateral recumbence may facilitate epidural puncture compared with neutral limb positioning.
Topics: Animals; Female; Hindlimb; Laboratory Animal Science; Lumbosacral Region; Male; Posture; Swine
PubMed: 31699185
DOI: 10.30802/AALAS-JAALAS-19-000064 -
European Spine Journal : Official... Oct 2022With the increase in life expectancy and consequent aging of the population, degenerative lumbar spine diseases tend to increase its number exponentially. Several... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
With the increase in life expectancy and consequent aging of the population, degenerative lumbar spine diseases tend to increase its number exponentially. Several treatment options are available to treat degenerative spinal diseases, such as laminectomies, posterior fusions, and interbody fusions, depending on their locations, correction necessities, and surgeon philosophy. With the advance in technology and surgical knowledge, minimally invasive techniques (MIS) arose as a solution to reduce surgical morbidity, while maintaining the same benefits as the traditionally/open surgeries. Several studies investigated the possible advantages of MIS techniques against the traditional open procedures. However, those articles are usually focused only on one technique or on one pathology.
METHODS
The electronic databases, including PubMed, Google Scholar, Ovid, and BVS, were systematically reviewed. Only original articles in English or Portuguese were added to the review, the revision was performed following the PRISMA guideline.
RESULTS
Fifty-three studies were included in the meta-analysis. Of the studied outcomes the Length of Stay Odds of complications, Blood Loss, and Surgery costs presented significantly favored MIS approaches, while the Last FUP ODI score, and Surgery Time did not differ among the groups.
CONCLUSION
Minimally invasive techniques are a remarkably interesting option to traditional open surgeries, as these procedures showed a significant reduction in blood loss, hospitalization time, complications, and surgical costs.
Topics: Humans; Lumbar Vertebrae; Lumbosacral Region; Minimally Invasive Surgical Procedures; Retrospective Studies; Spinal Fusion; Treatment Outcome
PubMed: 35871660
DOI: 10.1007/s00586-022-07327-3 -
Scientific Reports Jan 2021The overall goal of this work was to create a high-resolution MRI atlas of the lumbosacral enlargement of the spinal cord of the rat (Sprague-Dawley), cat, domestic pig,... (Comparative Study)
Comparative Study
The overall goal of this work was to create a high-resolution MRI atlas of the lumbosacral enlargement of the spinal cord of the rat (Sprague-Dawley), cat, domestic pig, rhesus monkey, and human. These species were chosen because they are commonly used in basic and translational research in spinal cord injuries and diseases. Six spinal cord specimens from each of the studied species (total of 30 specimens) were fixed, extracted, and imaged. Sizes of the spinal cord segments, cross-sectional dimensions, and locations of the spinal cord gray and white matter were quantified and compared across species. The lumbar enlargement spans spinal cord levels L3-S1 in rats, L4-S1 in cats, L3-S1 in pigs, L2/L3-L7/S1 in monkeys, and T12/L1-S1/S2 in humans. The enlargements in pigs and humans are largest and most similar in size (length and cross-sectional area); followed by monkeys and cats; and followed by rats. The obtained atlas establishes a neuroanatomical reference for the intact lumbosacral spinal cord in these species. It can also be used to guide the planning of surgical procedures of the spinal cord and technology design and development of spinal cord neuroprostheses, as well as precise delivery of cells/drugs into target regions within the spinal cord parenchyma.
Topics: Animals; Cats; Humans; Lumbosacral Region; Macaca mulatta; Neuroanatomy; Rats; Rats, Sprague-Dawley; Swine
PubMed: 33479371
DOI: 10.1038/s41598-021-81371-9 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Jun 2022To review and evaluate the technical advantages and disadvantages and research progress of percutaneous endoscopic lumbar interbody fusion. (Review)
Review
OBJECTIVE
To review and evaluate the technical advantages and disadvantages and research progress of percutaneous endoscopic lumbar interbody fusion.
METHODS
The domestic and foreign related research literature on percutaneous endoscopic lumbar interbody fusion was extensively consulted. The advantages, disadvantages, and effectiveness were summarized. And the development trend of this technology was prospected.
RESULTS
Compared with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), percutaneous endoscopic lumbar interbody fusion has less intraoperative and postoperative bleeding, better improvement of low back pain in the early stage after operation, and similar long-term effectiveness, fusion rate, and incidence of complication, but a longer learning curve. The operation time of biportal and large-channel uniportal endoscopic lumbar fusion is close to that of MIS-TLIF, but the operation time of small-channel uniportal endoscopic fusion is longer than that of MIS-TLIF.
CONCLUSION
Percutaneous endoscopic lumbar interbody fusion has the advantages of less trauma and good effectiveness, but its learning curve is long, and indications should be strictly selected for this operation. In the future, with the continuous development and complementation of various endoscopic fusion technologies, this technology will gain better application prospects.
Topics: Humans; Lumbar Vertebrae; Lumbosacral Region; Minimally Invasive Surgical Procedures; Retrospective Studies; Spinal Fusion; Treatment Outcome
PubMed: 35712920
DOI: 10.7507/1002-1892.202202075