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JNMA; Journal of the Nepal Medical... Feb 2022A weakening or defect in posterolateral abdominal wall can lead to development of lumbar hernia. These defects are particularly common in Petit's inferior triangle or...
A weakening or defect in posterolateral abdominal wall can lead to development of lumbar hernia. These defects are particularly common in Petit's inferior triangle or Grynfeltt-Lesshaft superior triangle. There are very few cases of primary lumbar hernias that have been described in literature till date. As it is a rare entity, it is often misdiagnosed, leading to delay in management. We present a case of a 66-year-old male with no previous surgery who presented with a mass in left lumbar region for last ten years. The mass gradually increased in size and caused vague dragging pain. On Computed tomography, the diagnosis of Grynfeltt hernia was made. The patient underwent a laparoscopic mesh repair and had an uneventful postoperative hospital stay. Although a rare entity, there should be a high degree of suspicion of a lumbar hernia when evaluating a case of a lumbar mass. Early diagnosis by computed tomography and management with open or minimally invasive techniques can prevent complications.
Topics: Abdominal Wall; Aged; Hernia, Abdominal; Humans; Laparoscopy; Lumbosacral Region; Male; Surgical Mesh
PubMed: 35210629
DOI: 10.31729/jnma.7251 -
Chinese Medical Journal May 2016Recent studies have suggested an association between elevated pelvic incidence (PI) and the development of lumbar spondylolysis. However, there is still lack of...
BACKGROUND
Recent studies have suggested an association between elevated pelvic incidence (PI) and the development of lumbar spondylolysis. However, there is still lack of investigation for Han Chinese people concerning the normal range of spinopelvic parameters and relationship between abnormal sagittal parameters and lumbar diseases. The objective of the study was to investigate sagittal lumbosacral parameters of adult lumbar spondylolysis patients in Han Chinese population.
METHODS
A total of 52 adult patients with symptomatic lumbar spondylolysis treated in the General Hospital of Armed Police Force (Beijing, China) were identified as the spondylolysis group. All the 52 patients were divided into two subgroups, Subgroup A: 36 patients with simple lumbar spondylolysis, and Subgroup B: 16 patients with lumbar spondylolysis accompanying with mild lumbar spondylolisthesis (slip percentage <30%). Altogether 207 healthy adults were chosen as the control group. All patients and the control group took lumbosacral lateral radiographs. Seven sagittal lumbosacral parameters, including PI, pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), L5 incidence, L5 slope, and sacral table angle (STA), were measured in the lateral radiographs. All the parameters aforementioned were compared between the two subgroups and between the spondylolysis group and the control group with independent-sample t- test.
RESULTS
There were no statistically significant differences of all seven sagittal lumbosacral parameters between Subgroup A and Subgroup B. PI, PT, SS, and LL were higher (P < 0.05) in the spondylolysis group than those in the control group, but STA was lower (P < 0.001) in the spondylolysis group.
CONCLUSIONS
Current study results suggest that increased PI and decreased STA may play important roles in the pathology of lumbar spondylolysis in Han Chinese population.
Topics: Adolescent; Adult; China; Female; Humans; Lumbosacral Region; Male; Middle Aged; Radiography; Spondylolysis; Young Adult
PubMed: 27174324
DOI: 10.4103/0366-6999.181972 -
The Journal of Physiology Jan 2020•Longissimus activity in the lumbar region was measured using indwelling electromyography to characterize the territory of its motor units. •The distribution of...
KEY POINTS
•Longissimus activity in the lumbar region was measured using indwelling electromyography to characterize the territory of its motor units. •The distribution of motor units in the longissimus pars lumborum muscle was mainly grouped into two distinct regions. •Regional activation of the longissimus pars lumborum was also observed during functional tasks involving trunk movements. •The regional activation of the longissimus pars lumborum muscle may play a role in segmental stabilization of the lumbar spine.
ABSTRACT
The longissimus pars lumborum contributes to lumbar postural control and movement. While animal studies suggest a segmental control of this muscle, the territory of motor units constituting the human longissimus pars lumborum remains unknown. The aims of this study were to identify the localization of motor unit territories in the longissimus and assess the activation of this muscle during functional tasks. Eight healthy participants were recruited. During isometric back extension contractions, single motor-unit (at L1, L2, L3 and L4) and multi-unit indwelling recordings (at L1, L1-L2, L2, L2-L3, L3, L3-L4 and L4) were used to estimate motor unit territories in the longissimus pars lumborum based on the motor-unit spike-triggered averages from fine-wire electrodes. A series of functional tasks involving trunk and arm movements were also performed. A total of 73 distinct motor units were identified along the length of the longissimus: only two motor units spanned all recording sites. The majority of the recorded motor units had muscle fibres located in two main rostro-caudal territories (32 motor units spanned L1 to L3 and 30 spanned ∼L3 to L4) and 11 had muscle fibres outside these two main territories. We also observed distinct muscle activation between the rostral and caudal regions of the longissimus pars lumborum during a trunk rotation task. Our results show clear rostral and caudal motor unit territories in the longissimus pars lumborum muscle and suggest that the central nervous system can selectively activate regions of the superficial lumbar muscles to provide local stabilization of the spine.
Topics: Arm; Electromyography; Humans; Isometric Contraction; Lumbar Vertebrae; Lumbosacral Region; Movement; Muscle, Skeletal; Torso
PubMed: 31654400
DOI: 10.1113/JP278260 -
BioMed Research International 2018Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive disc surgery that can be performed under local anesthesia and requires only an eight-mm skin...
PURPOSE
Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive disc surgery that can be performed under local anesthesia and requires only an eight-mm skin incision. For the patients with lumbar foraminal stenosis, the migrated disc is difficult to remove with a simple transforaminal approach. In such cases, the foraminoplasty techniques can be used. However, obtaining efficient foramen enlargement while minimizing radiation exposure and protecting the nerves can be challenging.
METHODS
In this study, we propose a new technique called the Kiss-Hug maneuver. Under endoscopic viewing, we used the bevel tip of a working cannula as a bone reamer to enlarge the foramen. This allowed us to efficiently enlarge the lumbar foramen endoscopically without the redundancy and complications associated with reamers or trephines.
RESULTS
Details of the four steps of the Kiss-Hug maneuver are reported along with adverse events. The advantages of this new technique include minimizing radiation exposure to both the surgeon and the patient and decreasing the overall operation time.
CONCLUSION
The endoscopic Kiss-Hug maneuver is a useful and reliable foraminoplasty technique that can enhance the efficiency of foraminoplasty while ensuring patient safety and reducing radiation exposure.
Topics: Cannula; Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Lumbosacral Region; Minimally Invasive Surgical Procedures
PubMed: 30671454
DOI: 10.1155/2018/4749560 -
Annals of Biomedical Engineering Jul 2022Prolonged microgravity results in muscle atrophy, especially among the anti-gravity spinal muscles. How individual paravertebral muscle groups change in size and...
Prolonged microgravity results in muscle atrophy, especially among the anti-gravity spinal muscles. How individual paravertebral muscle groups change in size and composition with spaceflight needs further exploration. This study investigates lumbar spine musculature changes among six crewmembers on long-duration space missions using non-invasive measurement of muscle changes with magnetic resonance imaging (MRI). Pre- and post-flight lumbar images were analyzed for changes in cross-sectional area, volume, and fat infiltration of the psoas (PS), quadratus lumborum (QL), and paraspinal [erector spinae and multifidus (ES + MF)] muscles using mixed models. Crewmembers used onboard exercise equipment, including a cycle ergometer (CEVIS), treadmill (T2/COLBERT), and the advanced resistive exercise device (ARED). Correlations were used to assess muscle changes related to exercise modality. There was substantial variability in muscle changes across crewmembers but collectively a significant decrease in paraspinal area (- 9.0 ± 4.8%, p = 0.04) and a significant increase in QL fat infiltration (7.3 ± 4.1%, p = 0.05). More CEVIS time may have protected against PS volume loss (p = 0.05) and PS fat infiltration (p < 0.01), and more ARED usage may have protected against ES + MF volume loss (p = 0.05). Crewmembers using modern onboard exercise equipment may be less susceptible to muscle changes. However, variability between crewmembers and muscle size and quality losses suggest additional research is needed to ensure in-flight countermeasures preserve muscle health.
Topics: Lumbar Vertebrae; Lumbosacral Region; Magnetic Resonance Imaging; Paraspinal Muscles; Space Flight
PubMed: 35459964
DOI: 10.1007/s10439-022-02968-3 -
European Radiology Jun 2020To assess the prevalence of lumbosacral transitional vertebra (LSTV) and associated spinal degenerative changes on abdominal CT scans in Caucasian population.
OBJECTIVES
To assess the prevalence of lumbosacral transitional vertebra (LSTV) and associated spinal degenerative changes on abdominal CT scans in Caucasian population.
MATERIAL AND METHODS
A total of 3855 abdominal CT scans of the year 2017 from a single hospital were retrospectively assessed for LSTV, disc degeneration (DD), and facet joint degeneration (FD). An age- and sex-matched 150-subject control group without LSTV was picked at random. Multivariable logistic regression was used for the analysis.
RESULTS
LSTV was found in 1101 (29%) scans: Castellvi type I in 68%, type II in 16%, type III in 13%, and type IV in 3% of scans. Age- and sex-adjusted prevalence of DD was significantly higher in Castellvi type II and III groups at multiple lumbar levels, and in IV group at L4/5 than in control group (p < 0.001-0.034). At L5/S1, the prevalence of DD was significantly higher in the control group than in type II, III, or IV groups (p < 0.001-0.017). After combining Castellvi types II, III, and IV into one group, significant differences were found at all lumbar levels except L2/3 (p < 0.001-0.016). Prevalence of FD was significantly higher at L4/5 in Castellvi groups I, II, and III than in the control group (p < 0.001-0.002). When Castellvi types II, III, and IV were combined into one group, significant differences were found at lumbar levels L2/3, L3/4, and L4/5 (p < 0.001-0.021).
CONCLUSION
Lumbosacral vertebrae of Castellvi types II, III, and IV are associated with greater lumbar degeneration, warranting meticulous evaluation of spinal anatomy, even on CT.
KEY POINTS
• Lumbosacral transitional vertebra is a common incidental finding on abdominal CT scans with a high prevalence of 29%. • When assessing whole lumbar spine, lumbosacral vertebrae of Castellvi types II, III, and IV were associated with greater lumbar degeneration, warranting careful evaluation of the lumbar spine on abdominal CT scans.
Topics: Abdomen; Adolescent; Adult; Aged; Aged, 80 and over; Anatomic Variation; Female; Humans; Intervertebral Disc Degeneration; Logistic Models; Lumbar Vertebrae; Lumbosacral Region; Male; Middle Aged; Prevalence; Retrospective Studies; Sacrum; Spondylosis; Tomography, X-Ray Computed; Young Adult
PubMed: 32072261
DOI: 10.1007/s00330-020-06691-2 -
Histopathology Jun 2018Lumbosacral lipomas (LSL) are congenital disorders of the terminal spinal cord region that have the potential to cause significant spinal cord dysfunction in children....
AIMS
Lumbosacral lipomas (LSL) are congenital disorders of the terminal spinal cord region that have the potential to cause significant spinal cord dysfunction in children. They are of unknown embryogenesis with variable clinical presentation and natural history. It is unclear whether the spinal cord dysfunction reflects a primary developmental dysplasia or whether it occurs secondarily to mechanical traction (spinal cord tethering) with growth. While different anatomical subtypes are recognised and classified according to radiological criteria, these subtypes correlate poorly with clinical prognosis. We have undertaken an analysis of surgical specimens in order to describe the spectrum of histological changes that occur and have correlated the histology with the anatomical type of LSL to determine if there are distinct histological subtypes.
METHODS AND RESULTS
The histopathology was reviewed of 64 patients who had undergone surgical resection of LSL. The presence of additional tissues and cell types were recorded. LSLs were classified from pre-operative magnetic resonance imaging (MRI) scans according to Chapman classification. Ninety-five per cent of the specimens consisted predominantly of mature adipocytes with all containing thickened bands of connective tissue and peripheral nerve fibres, 91% of samples contained ectatic blood vessels with thickened walls, while 22% contained central nervous system (CNS) glial tissue. Additional tissue was identified of both mesodermal and neuroectodermal origin.
CONCLUSIONS
Our analysis highlights the heterogeneity of tissue types within all samples, not reflected in the nomenclature. The diversity of tissue types, consistent across all subtypes, challenges currently held notions regarding the embryogenesis of LSLs and the assumption that clinical deterioration is due simply to tethering.
Topics: Adipocytes; Clinical Deterioration; Humans; Lipoma; Lumbosacral Region; Magnetic Resonance Imaging; Spinal Cord Neoplasms
PubMed: 29350777
DOI: 10.1111/his.13469 -
BMC Musculoskeletal Disorders Jan 2024Fifth lumbar vertebra (L5) spondylolysis has a lower bone union rate than non-L5 spondylolysis, but the reason for this is unknown. This study aimed to evaluate the...
BACKGROUND
Fifth lumbar vertebra (L5) spondylolysis has a lower bone union rate than non-L5 spondylolysis, but the reason for this is unknown. This study aimed to evaluate the differences in patient and lesion characteristics between L5 and non-L5 spondylolysis.
METHODS
A total of 410 patients with lumbar spondylolysis aged 18 years or younger who were treated conservatively were enrolled. Patients and lesions were divided into L5 and non-L5 (L2-L4) spondylolysis. Factors, including sex, age, presence of spina bifida occulta, stage of the main side lesion, whether the lesion was unilateral or bilateral, presence and stage of the contralateral side lesion and treatment duration, were evaluated at the first visit and compared between the two groups.
RESULTS
A total of 250 patients with 349 lesions were included. The bone union rate of L5 lesions was lower than that of non-L5 lesions (75% vs. 86%, p = 0.015). Patients with L5 spondylolysis were more likely to be male (86% vs. 66%) and younger (14.0 vs. 14.6 years) than patients with non-L5 spondylolysis. Lesions of L5 spondylolysis were more likely to be in a progressive stage (28% vs. 15%), less likely to be in a pre-lysis stage (28% vs. 43%) and more likely to be in a contralateral terminal stage (14% vs. 5.3%, p = 0.013) compared with lesions of non-L5 spondylolysis.
CONCLUSIONS
L5 spondylolysis was characterised by a lower bone union rate, more males, younger age, more progressive stage and more contralateral pseudarthrosis than non-L5 spondylolysis.
Topics: Humans; Male; Female; Spondylolysis; Lumbar Vertebrae; Lumbosacral Region
PubMed: 38216892
DOI: 10.1186/s12891-024-07190-x -
The Canadian Veterinary Journal = La... Apr 2007
Topics: Animals; Cauda Equina; Constriction, Pathologic; Diagnosis, Differential; Dog Diseases; Dogs; Lumbosacral Region; Magnetic Resonance Imaging; Male; Pain Measurement; Tomography, X-Ray Computed
PubMed: 17494374
DOI: No ID Found -
European Spine Journal : Official... Nov 2007A prospective study on 409 patients who received multimodel intraoperative monitoring (MIOM) during lumbosacral surgical procedures between March 2000 and December 2005...
A prospective study on 409 patients who received multimodel intraoperative monitoring (MIOM) during lumbosacral surgical procedures between March 2000 and December 2005 was carried out. The objective of this study was to determine the sensitivity and specificity of MIOM techniques used to monitor conus medullaris, cauda equina and nerve root function during lumbosacral decompression surgery. MIOM has increasingly become important to monitor ascending and descending pathways, giving immediate feedback information regarding any neurological deficit during the decompression and stabilisation procedure in the lumbosacral region. Intraoperative spinal- and cortical-evoked potentials, combined with continuous EMG- and motor-evoked potentials of the muscles, were evaluated and compared with postoperative clinical neurological changes. A total of 409 consecutive patients with lumbosacral spinal stenosis with or without instability were monitored by MIOM during the entire surgical procedure. A total of 388 patients presented true-negative findings while two patients presented false negative and 1 patient false-positive findings. Eighteen patients presented true-positive findings where neurological deficit after the operation was intraoperatively predicted. Of the 18 true-positive findings, 12 patients recovered completely; however, 6 patients recovered only partially. The sensitivity of MIOM applied during decompression and fusion surgery of the lumbosacral region was calculated as 90%, and the specificity was calculated as 99.7%. On the basis of the results of this study, MIOM is an effective method of monitoring the conus medullaris, cauda equina and nerve root function during surgery at the lumbosacral junctions and might reduce postoperative surgical-related complications and therefore improve the long-term results.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Lumbosacral Region; Male; Middle Aged; Monitoring, Intraoperative; Spinal Diseases
PubMed: 17912559
DOI: 10.1007/s00586-007-0432-9