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American Journal of Physiology.... Oct 2019We previously demonstrated that administration of norepinephrine, dopamine, and serotonin into the lumbosacral defecation center caused propulsive contractions of the...
We previously demonstrated that administration of norepinephrine, dopamine, and serotonin into the lumbosacral defecation center caused propulsive contractions of the colorectum. It is known that the monoamines in the spinal cord are released mainly from descending neurons in the brainstem. In fact, stimulation of the medullary raphe nuclei, the origin of descending serotonergic neurons, enhances colorectal motility via the lumbosacral defecation center. Therefore, the purpose of this study was to examine the roles of the noradrenergic nucleus locus coeruleus (LC) and dopaminergic nucleus A11 region in the defecation reflex. Colorectal motility was measured with a balloon in anesthetized rats. Electrical stimulation of the LC and A11 region increased colorectal pressure only when a GABA receptor antagonist was injected into the lumbosacral spinal cord. The effects of the LC stimulation and A11 region stimulation on colorectal motility were inhibited by antagonists of α1-adrenoceptors and D2-like dopamine receptors injected into the lumbosacral spinal cord, respectively. Spinal injection of a norepinephrine-dopamine reuptake inhibitor augmented the colokinetic effect of LC stimulation. The effect of stimulation of each nucleus was abolished by surgical severing of the parasympathetic pelvic nerves. Our findings demonstrate that activation of descending noradrenergic neurons from the LC and descending dopaminergic neurons from the A11 region causes enhancement of colorectal motility via the lumbosacral defecation center. The present study provides a novel concept that the brainstem monoaminergic nuclei play a role as supraspinal defecation centers. The present study demonstrates that electrical and chemical stimulations of the locus coeruleus or A11 region augment contractions of the colorectum. The effects of locus coeruleus and A11 stimulations on colorectal motility are due to activation of α1-adrenoceptors and D2-like dopamine receptors in the lumbosacral defecation center, respectively. The present study provides a novel concept that the brainstem monoaminergic nuclei play a role as supraspinal defecation centers.
Topics: Adrenergic alpha-1 Receptor Antagonists; Animals; Colon; Defecation; Dopamine; Dopamine Agonists; Electric Stimulation; Gastrointestinal Motility; Locus Coeruleus; Lumbosacral Region; Male; Norepinephrine; Rats; Rats, Sprague-Dawley; Receptors, Dopamine D2; Rectum; Spinal Cord; Sympathetic Nervous System
PubMed: 31460791
DOI: 10.1152/ajpgi.00062.2019 -
The British Journal of Radiology May 2017The objective of this review was to evaluate the efficacy of pulsed radiofrequency (PRF) treatment of pain associated with different spinal conditions. The mechanisms of... (Review)
Review
OBJECTIVE
The objective of this review was to evaluate the efficacy of pulsed radiofrequency (PRF) treatment of pain associated with different spinal conditions. The mechanisms of action and biological effects are shortly discussed to provide the scientific basis for this radiofrequency modality.
METHODS
We systematically searched for clinical studies on spinal clinical conditions using PRF. We searched the MEDLINE (PubMed) database. We classified the information in one table focusing on randomized controlled trials (RCTs) and other types of studies. Date of last electronic search was October 2016.
RESULTS
We found four RCTs that evaluated the efficacy of PRF on cervical radicular pain and five observational studies. Two trials and three observational studies were conducted in patients with facet pain. For disc-related pathology, we found one RCT with PRF applied intradiscally and three RCTs for dorsal root ganglia PRF modulation lumbosacral radicular pain. For sacroiliac joint pain, spondylolisthesis, malignancies and other minor spinal pathology, limited studies were conducted.
CONCLUSION
From the available evidence, the use of PRF to the dorsal root ganglion in cervical radicular pain is compelling. With regard to its lumbosacral counterpart, the use of PRF cannot be similarly advocated in view of the absence of standardization of PRF parameters, enrolment criteria and different methods in reporting results; but, the evidence is interesting. The use of PRF in lumbar facet pain was found to be less effective than conventional RF techniques. For the other different spinal conditions, we need further studies to assess the effectiveness of PRF. Advances in knowledge: The use of PRF in lumbar facet pain was found to be less effective than conventional RF techniques. For the other different spinal conditions, we need further studies to assess the effectiveness of PRF.
Topics: Back Pain; Humans; Lumbosacral Region; Pulsed Radiofrequency Treatment; Spinal Diseases; Treatment Outcome
PubMed: 28186832
DOI: 10.1259/bjr.20150406 -
Journal of Medical Case Reports Apr 2023Lumbar hernias are rare, with only 200-300 published cases listed in the literature. Two areas are described to have weakness points: the inferior lumbar triangle...
INTRODUCTION
Lumbar hernias are rare, with only 200-300 published cases listed in the literature. Two areas are described to have weakness points: the inferior lumbar triangle (Jean-Louis Petit triangle) and the superior lumbar triangle (Grynfeltt-Lesshaft triangle). Clinical diagnosis is confirmed by computed tomography and possibly by ultrasound or radiography. The surgeon must refine the clinical detection of this condition, as most patients do not have sufficient means to have a computed tomography scan performed, which remains the gold standard for diagnosis. Despite the different techniques recommended, the open route remains the most affordable in our environment.
CASE PRESENTATION
This case presents an 84-year-old black congolese patient consulted for bilateral swellings of the lumbar regions. The patient was married and in the farming profession for several years. The patient had no notion of trauma or fever and no notion of vomiting or stopping of materials and gases. The lumbar region presented with swellings that were ovoid, soft, painless, impulsive and expansive on coughing or hyperpressure, and non-pulsatile, measuring 9 × 7 cm in diameter (right) and 6 × 5 cm in diameter (left). Ultrasound performed of the upper costolumbal region revealed two lipomatous masses facing Grynfeltt's quadrilateral with a 1.5 cm hole on either side. The diagnosis of bilateral Grynfeltt hernia was made, and herniorrhaphy was indicated.
CONCLUSION
Grynfeltt-Lesshaft hernia is a rare surgical condition caused by congenital or acquired etiology. A lower back pain or a pain point localized on the hernia in addition to a lumbar mass that reduces when lying down suggests the diagnosis of lumbar hernia.
Topics: Humans; Aged, 80 and over; Lumbosacral Region; Hernia, Abdominal; Abdominal Wall; Herniorrhaphy; Tomography, X-Ray Computed
PubMed: 37020300
DOI: 10.1186/s13256-023-03874-5 -
Spine Jan 2015Systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis Review
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
To evaluate if patients with nonspecific chronic low back pain (NSCLBP) show a greater lumbar reposition error (RE) than healthy controls.
SUMMARY OF BACKGROUND DATA
Studies on lumbar RE in patients with NSCLBP present conflicting results.
METHODS
A systematic review and meta-analysis of the available literature were performed to evaluate differences in RE between patients with NSCLBP and healthy controls. Data on absolute error, constant error (CE), and variable error were extracted and effect sizes (ESs) were calculated. For the CE flexion pattern and active extension pattern, subgroups of patients with NSCLBP were analyzed. Results of homogeneous studies were pooled. Measurement protocols and study outcomes were compared. The quality of reporting and the authors' appraisal of risk of bias were investigated.
RESULTS
The original search revealed 178 records of which 13 fulfilled the inclusion criteria. The majority of studies showed that patients with NSCLBP produced a significantly larger absolute error (ES, 0.81; 95% confidence interval [95% CI], 0.13-1.49) and variable error (ES, 0.57; 95% CI, 0.05-1.09) compared with controls. CE is direction specific in flexion and active extension pattern subgroups of patients with NSCLBP (ES, 0.39; 95% CI, -1.09 to 0.3) and ES, 0.18; 95% CI, -0.3 to 0.65, respectively). The quality of reporting and the authors' appraisal of risk of bias varied considerably. The applied test procedures and instrumentation varied between the studies, which hampered the comparability of studies.
CONCLUSION
Although patients with NSCLBP seemed to produce a larger lumbar RE compared with healthy controls, study limitations render firm conclusions unsafe. Future studies should pay closer attention to power, precision, and reliability of the measurement approach, definition of outcome measures, and patient selection. We recommend a large, well-powered, prospective randomized control study that uses a standardized measurement approach and definitions for absolute error, CE, and variable error to address the hypothesis that proprioception may be impaired with CLBP.
Topics: Humans; Low Back Pain; Lumbar Vertebrae; Lumbosacral Region; Pain Measurement; Posture; Range of Motion, Articular
PubMed: 25575094
DOI: 10.1097/BRS.0000000000000677 -
Medicine Jun 2021Case-control studies by examining the lumbar spine computed tomography (CT) findings focusing on the spinous processes."Passing spine" was defined as a lumbar...
Case-control studies by examining the lumbar spine computed tomography (CT) findings focusing on the spinous processes."Passing spine" was defined as a lumbar degenerative change observed on CT images. In contrast, kissing spine, which is also an image finding, has been acknowledged as an established clinical condition. Therefore, we compared the passing spine group and the kissing spine group to investigate whether the 2 groups belong to a similar disease group; this would help explain the clinical and imaging characteristics of patients with passing spine.Previous studies have described the gradual increase in the height and thickness of the lumbar vertebral spinous processes that can occur in individuals aged >40 years, and reported that this progressive degeneration can lead to a condition termed "kissing spine."We examined the CT imaging of 373 patients with lumbar spinal disease and divided patients into 2 groups, the kissing spine (K) group and the passing spine (P) group, and compared the clinical (age, sex, presence/absence of lower extremity pain) and imaging data (localization of kissing or passing spine, intervertebral disc height at the level of kissing or passing spine, lumbar lordosis (LL) angle, presence/absence of vacuum phenomenon (VP) in the intervertebral discs and spondylolisthesis at the level of kissing or passing spine between the 2 groups.Compared with patients with kissing spine, patients with passing spine had an increased incidence of lower extremity pain, lower intervertebral disc height at the level of passing spine, relatively static LL, and VP commonly observed in the intervertebral discs at the level of passing spine.Because the clinical and imaging characteristics of patients with passing spine are different from those of patients with kissing spine, passing spine might be a pathological condition distinct from kissing spine.
Topics: Adult; Aged; Aged, 80 and over; Case-Control Studies; Female; Humans; Intervertebral Disc; Intervertebral Disc Degeneration; Lordosis; Lower Extremity; Lumbar Vertebrae; Lumbosacral Region; Male; Middle Aged; Somatoform Disorders; Spondylolisthesis; Tomography, X-Ray Computed; Vertebral Body
PubMed: 34087886
DOI: 10.1097/MD.0000000000026191 -
Acta Veterinaria Scandinavica May 2012Lumbosacral transitional vertebra (LTV) is a common congenital and hereditary anomaly in many dog breeds. It predisposes to premature degeneration of the lumbosacral...
BACKGROUND
Lumbosacral transitional vertebra (LTV) is a common congenital and hereditary anomaly in many dog breeds. It predisposes to premature degeneration of the lumbosacral junction, and is a frequent cause of cauda equina syndrome, especially in German shepherd dogs. Ventrodorsal hip radiographs are most often used in diagnosis of LTV in screening programs. In this study, value of laterolateral lumbar spine radiographs as additions to ventrodorsal radiographs in diagnosis of LTV, and characteristics of LTV and the eighth lumbar vertebra (L8) in laterolateral radiographs were studied. Additionally, computed tomography (CT) features of different types of LTV were elucidated.
METHODS
The ventrodorsal pelvic and laterolateral lumbar spine radiographs of 228 German shepherd dogs were evaluated for existence and type of LTV. Morphology of transverse processes was used in classification of LTV in ventrodorsal radiographs. The relative length of sixth (L6) and seventh (L7) vertebrae (L6/L7) was used in characterization of these vertebrae in laterolateral radiographs. CT studies were available for 16 dogs, and they were used for more detailed characterization of different types of LTV. Non-parametric χ2 statistics, generalized logit model for multinomial data, and one-way analysis of variance was used for statistical analyses.
RESULTS
In all, 92 (40%) dogs had a LTV, the most common type being separation of first spinous process from the median crest of the sacrum in 62 dogs (67% of LTV). Eight dogs had eight lumbar vertebrae. Those dogs with LTV had longer L7 in relation to L6 than dogs with normal lumbosacral junctions. When L6/L7 decreased by 0.1 units, the proportion of dogs belonging to the group with L8 was 14-fold higher than in the group with normal lumbosacral junctions. L8 resembled first sacral vertebra (S1) in length and position and was therefore classified as one type of LTV. With CT it was shown that categorizing LTV, based on shape and visibility of transverse processes seen in ventrodorsal radiographs, could be misleading.
CONCLUSIONS
We suggest that L8 be included as a part of the LTV complex, and the laterolateral radiographs of the lumbar spine be considered as an addition to ventrodorsal projections in the screening protocols for LTV.
Topics: Animals; Dog Diseases; Dogs; Female; Lumbar Vertebrae; Lumbosacral Region; Male; Polyradiculopathy; Radiography; Spinal Diseases; Tomography, X-Ray Computed
PubMed: 22549019
DOI: 10.1186/1751-0147-54-27 -
Journal of Neuroengineering and... Jan 2015The root mean square surface electromyographic activity of lumbar extensor muscles during dynamic trunk flexion and extension from a standing position and task specific...
BACKGROUND
The root mean square surface electromyographic activity of lumbar extensor muscles during dynamic trunk flexion and extension from a standing position and task specific spine ranges of motion objectively assess muscle function in healthy young and middle age individuals. However, literature on neuromuscular activation and associated spine and hip kinematics in older individuals is sparse. This cross sectional study sought to examine the sex and age (<40 versus >60 years) related differences in the neuromuscular activation profiles of the lumbar extensors and the related spine and hip kinematics from healthy individuals during a standardized trunk flexion-extension task.
METHODS
Twenty five older (13 females, 60-90 years) and 24 younger (12 females, 18-40 years) healthy individuals performed trunk flexion-extension testing by holding static positions at half-flexion way and full range of motion between standing and maximum trunk flexion. The associated lumbar extensor muscle activity was derived from measurements at standing, half, and maximum flexion positions. The range of motion at the hip and lumbar spine was recorded using 3d accelerometers attached to the skin overlying the multifidus and semispinalis thoracis muscles lateral to the L5 and T4 spinous processes, respectively. Statistical calculations were performed using a permutation ANOVA with bootstrap confidence intervals.
RESULTS
The muscle activity in the half related to the maximum flexion position (half flexion relaxation ratio) was significantly smaller in older males when compared with younger males. Moreover, measurements revealed smaller activity changes from standing to the half and from half to the maximum flexion position in older compared to younger individuals. Older males displayed smaller gross trunk range of motion from standing to maximum flexion than any other group.
CONCLUSIONS
Gender and normal aging significantly affect both the activation patterns of the lumbar extensor muscles and the kinematics of the trunk during a standardized trunk flexion-extension task. Measurement results from healthy young and middle age individuals should not be used for the assessment of individuals older than 60 years of age.
Topics: Accelerometry; Adolescent; Adult; Aged; Aged, 80 and over; Aging; Biomechanical Phenomena; Cross-Sectional Studies; Electromyography; Female; Hip; Humans; Lumbosacral Region; Male; Middle Aged; Movement; Muscle Strength Dynamometer; Muscle, Skeletal; Radionuclide Imaging; Sex Characteristics; Spine; Thorax; Young Adult
PubMed: 25566847
DOI: 10.1186/1743-0003-12-3 -
The Spine Journal : Official Journal of... Dec 2022The concept of sagittal spinal malalignment is well established in spinal surgery. However, the effect of musculature on its development has not been fully considered...
BACKGROUND CONTEXT
The concept of sagittal spinal malalignment is well established in spinal surgery. However, the effect of musculature on its development has not been fully considered and the position of the pelvis is mostly seen as compensatory and not necessarily a possible cause of sagittal imbalance.
PURPOSE
This study aimed to investigate the influence of the posterior paraspinal muscles (PPM, erector spinae, and multifidus) and the psoas muscle on spinopelvic and spinal alignment.
STUDY DESIGN/SETTING
Retrospective cross-sectional study.
PATIENT SAMPLE
Patients undergoing posterior lumbar fusion between 2014 and 2021 for degenerative conditions at a tertiary care center, with preoperative lumbar magnetic resonance imaging (MRI) within 12 months prior the surgery and a preoperative whole spine radiograph were included.
OUTCOME MEASURES
PPM and psoas muscle measurements including the cross-sectional area (CSA), the functional cross-sectional area (fCSA), the amount of intramuscular fat (FAT), and the percentage of fat infiltration (FI). Spinopelvic measurements including lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), and sagittal vertical axis (SVA).
METHODS
A T2-weighted MRI-based quantitative assessment of the CSA, the fCSA and the amount FAT was conducted, and FI was further calculated. The regions of interest included the psoas muscle and the PPM on both sides at the L4 level that were summarized and normalized by the patient's height (cm/m). LL, PT, SS, PI, and SVA were determined on standing lateral radiographs. Spearman correlation was used to calculate the crude relationship between spinopelvic and muscle parameters. Multiple linear regression models with age, sex, LL, PT, SS, and SVA set as independent variables were established to determine the association with spinal muscle outcome measures.
RESULTS
A total of 150 patients (53.3% female) were included in the final analysis with a median age of 65.6 years and a median BMI of 28.2 kg/m. Significant positive correlations were observed between PT (ρ=0.327), SVA (ρ=0.256) and PI (ρ=0.202) and the FI. Significant negative correlations were detected for the PT and the fCSA (ρ=-0.202) and PT and the fCSA (ρ=-0.191). Furthermore, a negative correlation was seen for PI and SVA and FI. PT (β=0.187; p=.006), SVA (β=0.155; p=.035), age (β=0.468; p<.001) and sex (β=0.235; p<.001) significantly predict FI (corrected R=0.393) as independent variables.
CONCLUSIONS
This study demonstrated the potential role of posterior paraspinal muscles and psoas muscle on pelvic retroversion and elucidated the relation to sagittal spinal malalignment. Although we cannot establish causality, we propose that increasing FI, representing loss of muscular strength, may lead to increased pelvic retroversion and thus might be the initiating point for the development of the sagittal imbalance. These findings might challenge the well-known theory of increased pelvic retroversion being a compensatory mechanism for sagittal spinal balance. Thus, muscular weakness might be a factor involved in the development of sagittal spinal malalignment.
Topics: Humans; Female; Aged; Male; Paraspinal Muscles; Retrospective Studies; Lumbar Vertebrae; Cross-Sectional Studies; Lumbosacral Region; Lordosis; Spinal Fusion
PubMed: 35944826
DOI: 10.1016/j.spinee.2022.07.103 -
The Journal of International Medical... Oct 2016Objective To investigate the impact of urethral catheterization on uroflow by comparing urodynamic parameters of free uroflowmetry versus pressure-flow study in adult...
Objective To investigate the impact of urethral catheterization on uroflow by comparing urodynamic parameters of free uroflowmetry versus pressure-flow study in adult patients with benign prostatic hyperplasia, female stress incontinence, lumbosacral spinal injury or spina bifida. Methods Each patient was required to perform pressure-flow study immediately following free uroflowmetry. Maximum flow rate (Q), average flow rate (Q), voided volume (VV), T (time to Q) and post-voiding residual urine (PVR) were compared between the two tests. Results Out of 120 patients, transurethral catheterization significantly impacted uroflow. In male patients with benign prostatic hyperplasia ( n = 50), Q, Q and T were significantly different between free uroflow and pressure-flow study. In patients with female stress incontinence ( n = 30), there were no statistically significant between-test differences in VV and T, but Q, Q and PVR were significantly different. In patients with spinal injury or spina bifida ( n = 40), Q, Q and VV were significantly different between free uroflow and pressure-flow study. Conclusion Urethral catheterization adversely impacts uroflow in patients with benign prostatic hyperplasia, female stress incontinence, spinal injury or spina bifida. Free uroflowmetry should be performed before pressure-flow study.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Lumbosacral Region; Male; Middle Aged; Prostatic Hyperplasia; Spinal Dysraphism; Urethra; Urinary Catheterization; Urinary Incontinence, Stress; Urination; Urodynamics
PubMed: 27565744
DOI: 10.1177/0300060516657700 -
BMC Musculoskeletal Disorders Sep 2016MRI is considered to be the diagnostic tool of choice in diagnosing nerve root compromise among patients presenting with clinical suspicion of lumbo-sacral... (Review)
Review
BACKGROUND
MRI is considered to be the diagnostic tool of choice in diagnosing nerve root compromise among patients presenting with clinical suspicion of lumbo-sacral radiculopathy. There exists controversy among researchers and clinicians regarding the diagnostic utility and accuracy of MRI in detecting nerve root compromise and radiculopathy. This review evaluated 4 primary diagnostic accuracy studies that specifically assessed the accuracy of MRI in detecting nerve root compromise, as established in the current literature.
METHODS
Eight electronic data bases were searched for relevant articles from inception until January 2014. All primary diagnostic studies which investigated the accuracy of MRI in diagnosing nerve root compromise among patients with low back and referred leg symptoms were screened for inclusion. Qualifying studies were retrieved and independently assessed for methodological quality using the 'Quality Assessment of Diagnostic tests Accuracy Studies' criteria.
RESULTS
Four studies qualified for inclusion in this review. The sensitivity of MRI in detecting lumbar nerve root compromise was very low at 0.25 (95 % CI) while the specificity was relatively high at 0.92 (95 % CI).
CONCLUSIONS
There is lack of sufficient high quality scientific evidence in support or against the use of MRI in diagnosing nerve root compression and radiculopathy. Therefore, clinicians should always correlate the findings of MRI with the patients' medical history and clinical presentation in clinical decision making.
Topics: Diffusion Tensor Imaging; Humans; Lumbosacral Region; Magnetic Resonance Imaging; Radiculopathy; Sensitivity and Specificity; Spinal Nerve Roots
PubMed: 27600883
DOI: 10.1186/s12891-016-1236-z