In this series,he patients with disturb-ance of small articulations of the lumbarvertebrae were treated by puncturing the ef-fective points and reduction by manual trac-tion with satisfactory results,the cure ratebein...In this series,he patients with disturb-ance of small articulations of the lumbarvertebrae were treated by puncturing the ef-fective points and reduction by manual trac-tion with satisfactory results,the cure ratebeing 39.3%,the markedly effective rate28.6%,with a total effective rate 98.3%.This method is simple and easy to master,and highly effective.Therefore it is very ac-ceptable to the patients.It is a very excellenttherapeutic method for disturbance of smallarticulations of the lumbar vertebrae,some-times complicated by acute lumbar sprainand chronic lumbar strain.展开更多
BACKGROUND Scedosporium apiospermum(S.apiospermum)is a clinically rare and aggressive fungus mainly found in contaminated water,wetlands,decaying plants,stagnant water,and potted plants in hospitals.The lung,bone,join...BACKGROUND Scedosporium apiospermum(S.apiospermum)is a clinically rare and aggressive fungus mainly found in contaminated water,wetlands,decaying plants,stagnant water,and potted plants in hospitals.The lung,bone,joint,eye,brain,skin,and other sites are easily infected,and there is a marked risk of misdiagnosis.There have been few case reports of infection by S.apiospermum of the lumbar vertebrae;most reports have focused on infection of the lung.CASE SUMMARY An otherwise healthy 60-year-old man presented with a 4-mo history of lumbosacral pain,stooping,and limited walking.The symptoms were significantly aggravated 10 d prior to hospitalization,and radiating pain in the back of his left lower leg developed,which was so severe that he could not walk.Movement of the lumbar spine was significantly limited,anterior flexion was about 30°;backward extension,right and left lateral curvature,and rotational mobility were about 10°;tenderness of the spinous processes of the lumbar 3-5 vertebrae was evident,and the muscle strength of both lower limbs was gradeⅣ.Imaging suggested bony destruction of the lumbar 3,4,and 5 vertebrae and sacral 1 vertebra;in addition,the corresponding intervertebral spaces were narrowed and the lumbar 5 vertebra was posteriorly displaced and unstable.Lumbar vertebral infection was also noted,and the possibility of lumbar tuberculosis was considered.We first performed surgical intervention on the lesioned lumbar vertebrae,cleared the infected lesion,and performed stable fixation of the lesioned vertebral body using a lumbar internal fixation device,which restored the stability of the lumbar vertebrae.Cytological and pathological examination of the lesioned tissue removed during surgery confirmed S.apiospermum infection of the lumbar vertebrae;on this basis,the patient was administered voriconazole.At the 6-mo followup,efficacy was significant,no drug-related side effects were observed,and imaging examination showed no evidence of recurrence.CONCLUSION S.apiospermum infection can occur in immunocompetent individuals with no history of near drowning.Voriconazole is effective for the treatment of S.apiospermum infection of the lumbar vertebrae for which it is suitable as the first-line therapy.展开更多
Traumatic brain inju ry-induced unfavorable outcomes in human patients have independently been associated with dysregulated levels of monoamines,especially epinephrine,although few preclinical studies have examined th...Traumatic brain inju ry-induced unfavorable outcomes in human patients have independently been associated with dysregulated levels of monoamines,especially epinephrine,although few preclinical studies have examined the epinephrine level in the central nervous system after traumatic brain injury.Epinephrine has been shown to regulate the activities of spinal motoneurons as well as increase the heart rate,blood pressure,and blood flow to the hindlimb muscles.Therefore,the purpose of the present study was to determine the impact of repeated blast-induced traumatic brain injury on the epinephrine levels in seve ral function-s pecific central nervous system regions in rats.Following three repeated blast injuries at 3-day intervals,the hippocampus,motor cortex,locus coeruleus,vestibular nuclei,and lumbar spinal cord were harvested at post-injury day eight and processed for epinephrine assays using a high-sensitive electrochemical detector cou pled with high-performance liquid chromatography.Our results showed that the epinephrine levels were significantly decreased in the lumbar spinal cord tissues of blast-induced traumatic brain injury animals compared to the levels detected in age-and sex-matched sham controls.In other function-specific central nervous system regions,although the epinephrine levels were slightly altered following blast-induced tra u matic brain injury,they were not statistically significant.These results suggest that blast injury-induced significant downregulation of epinephrine in the lumbar spinal cord could negatively impact the motor and cardiovascular function.This is the first repo rt to show altered epinephrine levels in the spinal cord following repetitive mild blast-induced traumatic brain injury.展开更多
Although quantitative trait loci(QTLs) for number of thoracic-lumbar vertebrae have been identified on Sus scrofa chromosomes(SSCs) 1 and 7, the influence of these QTLs on the thoracic and lumbar vertebrae is not ...Although quantitative trait loci(QTLs) for number of thoracic-lumbar vertebrae have been identified on Sus scrofa chromosomes(SSCs) 1 and 7, the influence of these QTLs on the thoracic and lumbar vertebrae is not clear. The aim of this study was to identify single nucleotide polymorphisms(SNPs) associated with total number of thoracic-lumbar vertebrae and for each trait(number of thoracic and lumbar vertebrae) separately. A total of 581 individuals from an F2 Large White×Minzhu population were genotyped using an SNP60 K chip. Performing a genome-wide association study(GWAS) for total number of thoracic-lumbar vertebrae, 38 significant SNPs were identified in two QTL regions located on SSC1 and SSC7. Performing a GWAS for number of thoracic vertebrae only, 72 significant SNPs were located on SSC7. While performing a GWAS for number of lumbar vertebrae only, 17 significant SNPs were identified on SSC1. Gene mining suggested that the gene encoding orphan nuclear receptor, germ cell nuclear factor(NR6A1) on SSC1 was a strong candidate affecting the number of lumbar vertebrae in pigs. Additionally, genes encoding vertnin(VRTN), prospero homeobox 2(PROX2), Finkel-Biskis-Jinkins murine osteosarcoma viral oncogene homolog(FOS), and transforming growth factor beta 3(TGFB3) may be important candidates affecting the number of thoracic vertebrae in pigs. QTLs on SSC1 and SSC7 independently influenced the numbers of thoracic and lumbar vertebrae. These results shed light on the complex genetic background of vertebrae development in pigs.展开更多
BACKGROUND Indirect decompression is one of the potential benefits of anterior reconstruction in patients with spinal stenosis.On the other hand,the reported rate of revision surgery after indirect decompression highl...BACKGROUND Indirect decompression is one of the potential benefits of anterior reconstruction in patients with spinal stenosis.On the other hand,the reported rate of revision surgery after indirect decompression highlights the necessity of working out prediction models for the radiographic results of indirect decompression with assessing their clinical relevance.AIM To assess factors that influence radiographic and clinical results of the indirect decompression in patients with stenosis of the lumbar spine.METHODS This study is a single-center cross-sectional evaluation of 80 consecutive patients(17 males and 63 females)with lumbar spinal stenosis combined with the instability of the lumbar spinal segment.Patients underwent single level or bisegmental spinal instrumentation employing oblique lumbar interbody fusion(OLIF)with percutaneous pedicle screw fixation.Radiographic results of the indirect decompression were assessed using computerized tomography,while MacNab scale was used to assess clinical results.RESULTS After indirect decompression employing anterior reconstruction using OLIF,the statistically significant increase in the disc space height,vertebral canal square,right and left lateral canal depth were detected(Р<0.0001).The median(M)relative vertebral canal square increase came toМ=24.5%with 25%-75%quartile border(16.3%;33.3%)if indirect decompression was achieved by restoration of the segment height.In patients with the reduction of the upper vertebrae slip,the median of the relative increase in vertebral canal square accounted for 49.5%with 25%-75%quartile border(2.35;99.75).Six out of 80 patients(7.5%)presented with unsatisfactory results because of residual nerve root compression.The critical values for lateral recess depth and vertebral canal square that were associated with indirect decompression failure were 3 mm and 80 mm2 respectively.CONCLUSION Indirect decompression employing anterior reconstruction is achieved by the increase in disc height along the posterior boarder and reduction of the slipped vertebrae in patients with degenerative spondylolisthesis.Vertebral canal square below 80 mm2 and lateral recess depth less than 3 mm are associated with indirect decompression failures that require direct microsurgical decompression.展开更多
Objective To investigate surgical strategy for high-grade isthmic spondylolisthesis(more thanⅡ degree)of 5th lumbar vertebrae.Methods From August 2003 to October 2008,26 patients with high-grade isthmic spondylolisth...Objective To investigate surgical strategy for high-grade isthmic spondylolisthesis(more thanⅡ degree)of 5th lumbar vertebrae.Methods From August 2003 to October 2008,26 patients with high-grade isthmic spondylolisthesis (L5) were展开更多
BACKGROUND This reported procedure combines the orthopedic surgical robot with the unilateral biportal endoscopy-lumbar interbody fusion(UBE-LIF),utilizing the UBE's wide viewing field and operating space to perfo...BACKGROUND This reported procedure combines the orthopedic surgical robot with the unilateral biportal endoscopy-lumbar interbody fusion(UBE-LIF),utilizing the UBE's wide viewing field and operating space to perform minimally invasive decompressive fusion of the lesioned segment,and the orthopedic surgical robot's intelligence and precision to perform percutaneous pedicle screw placement.The advancement of this procedure lies in the superposition of advantages and offsetting disadvantages of the two new technologies,and the maximum effect of treatment is achieved with maximum minimization of invasiveness and precision under the monitoring of imaging instruments to maximize the benefit of patients,and this review reports a case of multiple-segment lumbar decompression and fusion surgery for lumbar disc herniation via robot-assisted UBE for reference.CASE SUMMARY A 44-year-old patient presented to our hospital.Combining various clinical data,we diagnosed the patient with lumbar disc herniation with radiculopathy,lumbar spondylolisthesis,and lumbar spinal stenosis.We developed a surgical plan of"UBE decompression+UBE-LIF+orthopedic surgery robot-assisted percutaneous pedicle screw implantation for internal fixation".The results were satisfactory.CONCLUSION We present an extremely rare case of multiple-segment lumbar decompression and fusion surgery for lumbar disc herniation via robot-assisted UBE and achieved good results.Therefore,the technique is worthy of clinical promotion.展开更多
BACKGROUND Lumbar disc herniation(LDH)commonly occurs during spinal surgery;LDH is on the increase in younger patients and is classified as"paralysis"and"back pain."Sanhanchushi Tongbi(SPST)is a cu...BACKGROUND Lumbar disc herniation(LDH)commonly occurs during spinal surgery;LDH is on the increase in younger patients and is classified as"paralysis"and"back pain."Sanhanchushi Tongbi(SPST)is a customized prescription.It disperses cold,relieves pain,removes cold from the meridians and viscera,and treats neuropathic pain.However,few studies have investigated its mechanism of pain relief.AIM To observe the clinical therapeutic effects on LDH treated with self-prescribed SPST.METHODS A total of 211 patients with LDH syndrome were divided into two groups:107 patients in the control group were treated with conventional massage combined with traction,and 104 patients in the observation group were treated with a combination of the control regimen and self-prescribed oral SPST.The patients were treated for 4 wk.Indices of traditional Chinese medicine(TCM)syndrome score and serum inflammatory factor levels were measured.RESULTS After therapy,the TCM syndrome score in the observation group was significantly lower than that in the control group(P<0.05).The main symptoms,clinical signs,daily activities,and Japanese Orthopedic Association scores in the observation group were significantly higher than those in the control group after therapy(P<0.05).The levels of tumor necrosis factor-α,interleukin-6,and C-reactive protein were lower in the observation group than in the control group(P<0.05).In the observation group,superoxide dismutase levels were significantly higher,whereas malondialdehyde levels were significantly lower,compared with the control group(P<0.05).The overall efficacy rate in the observation group was 96.15%,which was substantially higher than that in the control group(88.79%;P<0.05).CONCLUSION Self-prescribed SPST can reduce the levels of inflammatory and pain-causing factors as well as lumbar pain in patients with LDH.展开更多
AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back pain.METHODS: The review process applied systematic evidence-based assessment methodol...AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back pain.METHODS: The review process applied systematic evidence-based assessment methodology of controlled trials of diagnostic validity and randomized controlled trials of therapeutic efficacy. Inclusion criteria encompassed all facet joint interventions performed in a controlled fashion. The pain relief of greater than 50% was the outcome measure for diagnostic accuracy assessment of the controlled studies with ability to perform previously painful movements, whereas, for randomized controlled therapeutic efficacy studies, the primary outcome was significant pain relief and the secondary outcome was a positive change in functional status. For the inclusion of the diagnostic controlled studies, all studies must have utilized either placebo controlled facet joint blocks or comparative local anesthetic blocks. In assessing therapeutic interventions, short-term and long-term reliefs were defined as either up to 6 mo or greater than 6 mo of relief. The literature search was extensive utilizing various types of electronic search media including Pub Med from 1966 onwards, Cochrane library, National Guideline Clearinghouse, clinicaltrials.gov, along with other sources includingprevious systematic reviews, non-indexed journals, and abstracts until March 2015. Each manuscript included in the assessment was assessed for methodologic quality or risk of bias assessment utilizing the Quality Appraisal of Reliability Studies checklist for diagnostic interventions, and Cochrane review criteria and the Interventional Pain Management Techniques- Quality Appraisal of Reliability and Risk of Bias Assessment tool for therapeutic interventions. Evidence based on the review of the systematic assessment of controlled studies was graded utilizing a modified schema of qualitative evidence with best evidence synthesis, variable from level Ⅰ to level Ⅴ.RESULTS: Across all databases, 16 high quality diagnostic accuracy studies were identified. In addition, multiple studies assessed the influence of multiple factors on diagnostic validity. In contrast to diagnostic validity studies, therapeutic efficacy trials were limited to a total of 14 randomized controlled trials, assessing the efficacy of intraarticular injections, facet or zygapophysial joint nerve blocks, and radiofrequency neurotomy of the innervation of the facet joints. The evidence for the diagnostic validity of lumbar facet joint nerve blocks with at least 75% pain relief with ability to perform previously painful movements was level Ⅰ, based on a range of level Ⅰ to Ⅴ derived from a best evidence synthesis. For therapeutic interventions, the evidence was variable from level Ⅱ to Ⅲ, with level Ⅱ evidence for lumbar facet joint nerve blocks and radiofrequency neurotomy for long-term improvement(greater than 6 mo), and level Ⅲ evidence for lumbosacral zygapophysial joint injections for short-term improvement only.CONCLUSION: This review provides significant evidence for the diagnostic validity of facet joint nerve blocks, and moderate evidence for therapeutic radiofrequency neurotomy and therapeutic facet joint nerve blocks in managing chronic low back pain.展开更多
Percutaneous Transforaminal Endoscopic Discectomy is a minimally invasive surgery with little pain, less blood loss, less hospital stay and the surgery can be done in local anesthesia, which was started during late 20...Percutaneous Transforaminal Endoscopic Discectomy is a minimally invasive surgery with little pain, less blood loss, less hospital stay and the surgery can be done in local anesthesia, which was started during late 20th century. Kambin and Gellmann in 1973 in the United States and Hijikata in Japanin 1977 individually preformed posterolateral percutaneous nucleotomy for the resection of the nucleus pulposus and release of compressed exiting nerve root, which is now spreading through the world and many surgeons are developing their skill but it needs experience and patience for successful outcomes. Along with advanced instruments now the surgery can be performed only giving a small skin incision of 8 - 10 mm and is as effective as the conventional method of surgery and open microdiscectomy surgery for the treatment of symptomatic lumbar disc herniation. In this review, we are explaining the technique of minimally invasive Percutaneous Transforaminal Endoscopic Discectomy surgery along its advantages and complications which can be encountered while performing this technique.展开更多
Background: Pneumatic arterial tourniquet is a utilized strategy in limb surgeries to provide bloodless field to facilitate surgical procedure. Be that as it may, arterial tourniquet has numerous injurious impacts inc...Background: Pneumatic arterial tourniquet is a utilized strategy in limb surgeries to provide bloodless field to facilitate surgical procedure. Be that as it may, arterial tourniquet has numerous injurious impacts including hemodynamic changes and tourniquet-induced pain which sometimes can be severe and intolerable. Objectives: Our primary aim was to assess the impact of performing “Lumbar Plexus Block and sciatic nerve block” with General Anesthesia (GA) on the degree of arterial tourniquet-induced hemodynamic effects. On the other hand, our secondary aims were: amount of postoperative analgesic prerequisites, patient satisfactory score and documented side effects. Settings and Design: Ain Shams University, Orthopedic operating theatre;a prospective, randomized, double-blind study. Methods and Material: The physical status of 50 patients (both sexes) including I and II patients from American Society of Anesthesiologists, whose ages are from 20 - 40 years, is not so ideal when they are undergoing elective knee Arthroscopy. The duration lasts no more than ninety minutes under GA with application of tourniquet. Patients were allotted haphazardly to one of two groups. In Group C (Control group): Only GA. In Group B: LPB and sciatic nerve block were performed just before GA administration. Intraoperative hemodynamics was recorded at specific timings. Results: Incidence of tourniquet induced hypertension (TIH) was markedly less with Group B at: forty five, sixty, seventy five mins after tourniquet inflation and just before tourniquet deflation. Also, the total ketorolac consumption during first 24 hours of postoperative period was significantly less with Group B (p Conclusions: Combined Sciatic-Lumbar plexus blocks when combined with general anesthesia were very effective in attenuating TIH.展开更多
目的探讨后路椎弓根螺钉内固定加椎体间BAK融合手术治疗低度(Ⅰ~Ⅱ度)腰椎滑脱症的临床与放射学结果的变化.方法行椎弓根螺钉内固定加椎体间融合器BAK融合者共26例.峡部不连性18例,退变性8例.L4滑脱14例、L5滑脱12例.测量所有患者的术...目的探讨后路椎弓根螺钉内固定加椎体间BAK融合手术治疗低度(Ⅰ~Ⅱ度)腰椎滑脱症的临床与放射学结果的变化.方法行椎弓根螺钉内固定加椎体间融合器BAK融合者共26例.峡部不连性18例,退变性8例.L4滑脱14例、L5滑脱12例.测量所有患者的术前、术后、最后一次随访的站立位侧位x线片,测量项目包括腰椎曲线指数(index of 1umbarspinal curvature,LCI)、L4、5、L5S1节段前凸角、全腰椎前凸角.结果排除1例未融合数据,术后融合节段的节段前凸角明显改善,且经随访后无明显丢失.术前、术后、随访时全腰椎前凸角与LCI的差别无显著性意义.结论后路椎弓根螺钉内固定加椎体间BAK融合治疗腰椎滑脱症可以有效改善并维持腰椎的正常生理曲线.展开更多
Introduction: Even though lumbar puncture (LP) represents an important tool in the diagnosis of certain neurological diseases, this procedure is little practiced by our students. We aimed to evaluate the attitudes and...Introduction: Even though lumbar puncture (LP) represents an important tool in the diagnosis of certain neurological diseases, this procedure is little practiced by our students. We aimed to evaluate the attitudes and practices of students, interns, and residents about LP, and to assess their feelings about how this procedure is taught. Materials and Methods: We conducted a cross-sectional study of 160 participants, using an anonymous questionnaire, to evaluate the attitudes and practices of students, interns and residents in the pediatrics department concerning lumbar puncture. Results: Half of the participants had never performed LP, usually because of the risk involved or lack of confidence, while 20% had performed it more than 4 times. None of the participants had learned to perform the procedure through simulation sessions, while (42%) had learned it under the supervision of a senior physician and had not been able to perform it successfully the first time. Most participants inform the patient about the procedure before performing it. Only 44% of participants acknowledged that LP can be performed under local anesthetic. The sitting position (60%) was by far the most commonly used. Most LPs were performed for diagnostic purposes. Most participants stated that the pediatric ward and the pediatric emergency department are among the departments that perform LP most frequently, and that they would be interested in taking part in simulated lumbar puncture sessions in children in the future. Conclusion: The results of our study show that LP is perceived by students as a risky procedure that is difficult to perform. Teachers should reconsider how this technical procedure is taught, by integrating simulation on mannequins into student training.展开更多
Background:The incidence of lumbar disc herniation(LDH)is notably high.Consensus among experts highlights non-surgical treatments as the primary therapeutic approach for LDH.Contemporary medicine frequently employs ph...Background:The incidence of lumbar disc herniation(LDH)is notably high.Consensus among experts highlights non-surgical treatments as the primary therapeutic approach for LDH.Contemporary medicine frequently employs pharmacotherapy and epidural injections in such treatments,which are associated with numerous adverse effects.Prolonged use can severely impair the liver and kidney functions of patients.Hence,the role of safe and effective traditional Chinese medicine techniques becomes pivotal.Among various traditional Chinese medicine approaches for treating LDH,fire dragon cupping,renowned for its remarkable efficacy,cost-effectiveness,and ease of application,is extensively utilised in clinical settings for managing LDH.Nonetheless,there is a scarcity of systematic and standardised evidence from evidence-based medicine studies.Therefore,conducting a meta-analysis is imperative.Methods:A comprehensive computerised search was conducted in databases including China National Knowledge Infrastructure,WanFang Data,VIP,China Biology Medicine disc,PubMed,EMbase,The Cochrane Library,Web of Science,and CINAHL.The search aimed to gather randomised controlled trials on fire dragon cupping therapy for LDH,spanning from the inception of these databases until December 2023.Two researchers independently screened the literature according to inclusion and exclusion criteria,extracted data,and assessed the methodological quality of the studies included,utilising RevMan 5.3 software for meta-analysis.Results:The results show that the fire dragon cupping therapy group had better clinical effectiveness(relative risk=1.23,95%confidence interval(CI)(1.14,1.33),P<0.00001),less pain(standardized mean difference=–1.33,95%CI(–1.49,–1.16),P<0.00001),and some improvement in lumbar function(Japanese Orthopaedic Association scores:mean difference=3.37,95%CI(2.31,4.43),P<0.00001.Conclusion:The fire dragon cupping therapy significantly alleviates LDH,warranting its extensive application.However,considering the limitations in the number and quality of studies included,the aforementioned conclusion necessitates further validation through more high-quality research.展开更多
BACKGROUND Lumbar radiculopathy spondylosis is a relatively common orthopedic disease with a high incidence rate.It most commonly occurs in the lumbar 4-5 and lumbar 5-sacral 1 vertebrae,which account for approximatel...BACKGROUND Lumbar radiculopathy spondylosis is a relatively common orthopedic disease with a high incidence rate.It most commonly occurs in the lumbar 4-5 and lumbar 5-sacral 1 vertebrae,which account for approximately 95%of cases.It mostly occurs in people aged 30-50 years old and greatly affects their quality of life.AIM To determine the effect of triple-voltage acupuncture combined with helium-neon laser irradiation on the quality of care and improvement of symptoms in patients with lumbar radiculopathy spondylolisthesis.METHODS In this study,we selected 120 patients with lumbar radiculopathy spondylosis who were treated at our hospital between June 2019 to June 2020.The patients were divided into control and observation groups according to the random number table method,with 60 patients in each group.Patients in the observation group were treated with three-volt moxibustion combined with helium-neon laser irradiation,and those in the control group were treated with lumbar traction.After 1 month of treatment,the lumbar pain scores,lumbar spine motor functions,clinical treatment effects,and nursing satisfaction of the two groups were compared.RESULTS The results showed that acupuncture combined with laser irradiation significantly improved the patients'clinical symptoms,i.e.,reduced their low back pain,significantly lower numerical rating scale pain scores in the observation group than in the control group,and better lumbar spine motility than in the control group,compared to lumbar traction.In addition,they were cared for.The treatment effectiveness rate of the observation group was 95.5%,which was significantly higher than that of the control group(81.67%).Satisfaction with care was higher than 90 points in both groups,but the difference was not statistically significant.CONCLUSION Our study provides a clinical rationale for the future treatment of patients with lumbar spine disease.However,further extensive research is needed for validation.展开更多
文摘In this series,he patients with disturb-ance of small articulations of the lumbarvertebrae were treated by puncturing the ef-fective points and reduction by manual trac-tion with satisfactory results,the cure ratebeing 39.3%,the markedly effective rate28.6%,with a total effective rate 98.3%.This method is simple and easy to master,and highly effective.Therefore it is very ac-ceptable to the patients.It is a very excellenttherapeutic method for disturbance of smallarticulations of the lumbar vertebrae,some-times complicated by acute lumbar sprainand chronic lumbar strain.
基金Supported by Chinese People’s Liberation Army Medical Technology Youth Training Program,No. 20QNPY071
文摘BACKGROUND Scedosporium apiospermum(S.apiospermum)is a clinically rare and aggressive fungus mainly found in contaminated water,wetlands,decaying plants,stagnant water,and potted plants in hospitals.The lung,bone,joint,eye,brain,skin,and other sites are easily infected,and there is a marked risk of misdiagnosis.There have been few case reports of infection by S.apiospermum of the lumbar vertebrae;most reports have focused on infection of the lung.CASE SUMMARY An otherwise healthy 60-year-old man presented with a 4-mo history of lumbosacral pain,stooping,and limited walking.The symptoms were significantly aggravated 10 d prior to hospitalization,and radiating pain in the back of his left lower leg developed,which was so severe that he could not walk.Movement of the lumbar spine was significantly limited,anterior flexion was about 30°;backward extension,right and left lateral curvature,and rotational mobility were about 10°;tenderness of the spinous processes of the lumbar 3-5 vertebrae was evident,and the muscle strength of both lower limbs was gradeⅣ.Imaging suggested bony destruction of the lumbar 3,4,and 5 vertebrae and sacral 1 vertebra;in addition,the corresponding intervertebral spaces were narrowed and the lumbar 5 vertebra was posteriorly displaced and unstable.Lumbar vertebral infection was also noted,and the possibility of lumbar tuberculosis was considered.We first performed surgical intervention on the lesioned lumbar vertebrae,cleared the infected lesion,and performed stable fixation of the lesioned vertebral body using a lumbar internal fixation device,which restored the stability of the lumbar vertebrae.Cytological and pathological examination of the lesioned tissue removed during surgery confirmed S.apiospermum infection of the lumbar vertebrae;on this basis,the patient was administered voriconazole.At the 6-mo followup,efficacy was significant,no drug-related side effects were observed,and imaging examination showed no evidence of recurrence.CONCLUSION S.apiospermum infection can occur in immunocompetent individuals with no history of near drowning.Voriconazole is effective for the treatment of S.apiospermum infection of the lumbar vertebrae for which it is suitable as the first-line therapy.
基金supported by the United States Department of Veterans Affairs Rehabilitation Research and Development Service (RR&D)[Merit Review Award numbers B3123-I/101 RX003123 and B3986-R/I01 RX003986-01A1]。
文摘Traumatic brain inju ry-induced unfavorable outcomes in human patients have independently been associated with dysregulated levels of monoamines,especially epinephrine,although few preclinical studies have examined the epinephrine level in the central nervous system after traumatic brain injury.Epinephrine has been shown to regulate the activities of spinal motoneurons as well as increase the heart rate,blood pressure,and blood flow to the hindlimb muscles.Therefore,the purpose of the present study was to determine the impact of repeated blast-induced traumatic brain injury on the epinephrine levels in seve ral function-s pecific central nervous system regions in rats.Following three repeated blast injuries at 3-day intervals,the hippocampus,motor cortex,locus coeruleus,vestibular nuclei,and lumbar spinal cord were harvested at post-injury day eight and processed for epinephrine assays using a high-sensitive electrochemical detector cou pled with high-performance liquid chromatography.Our results showed that the epinephrine levels were significantly decreased in the lumbar spinal cord tissues of blast-induced traumatic brain injury animals compared to the levels detected in age-and sex-matched sham controls.In other function-specific central nervous system regions,although the epinephrine levels were slightly altered following blast-induced tra u matic brain injury,they were not statistically significant.These results suggest that blast injury-induced significant downregulation of epinephrine in the lumbar spinal cord could negatively impact the motor and cardiovascular function.This is the first repo rt to show altered epinephrine levels in the spinal cord following repetitive mild blast-induced traumatic brain injury.
基金supported by the Agricultural Science and Technology Innovation Program, China (ASTIP-IAS02)the National Key Technology R&D Program of China (2011BAD28B01)+3 种基金the National Natural Science Foundation of China (31201781)the Earmarked Fund for Modern Agro-Industry Technology Research Systemthe National Key Technology R&D Program of China (2011ZX08006-003)the Chinese Academy of Agricultural Sciences Foundation (2014ZL006, 2011cj-5, 2012ZL069 and 2014ywf-yb-8)
文摘Although quantitative trait loci(QTLs) for number of thoracic-lumbar vertebrae have been identified on Sus scrofa chromosomes(SSCs) 1 and 7, the influence of these QTLs on the thoracic and lumbar vertebrae is not clear. The aim of this study was to identify single nucleotide polymorphisms(SNPs) associated with total number of thoracic-lumbar vertebrae and for each trait(number of thoracic and lumbar vertebrae) separately. A total of 581 individuals from an F2 Large White×Minzhu population were genotyped using an SNP60 K chip. Performing a genome-wide association study(GWAS) for total number of thoracic-lumbar vertebrae, 38 significant SNPs were identified in two QTL regions located on SSC1 and SSC7. Performing a GWAS for number of thoracic vertebrae only, 72 significant SNPs were located on SSC7. While performing a GWAS for number of lumbar vertebrae only, 17 significant SNPs were identified on SSC1. Gene mining suggested that the gene encoding orphan nuclear receptor, germ cell nuclear factor(NR6A1) on SSC1 was a strong candidate affecting the number of lumbar vertebrae in pigs. Additionally, genes encoding vertnin(VRTN), prospero homeobox 2(PROX2), Finkel-Biskis-Jinkins murine osteosarcoma viral oncogene homolog(FOS), and transforming growth factor beta 3(TGFB3) may be important candidates affecting the number of thoracic vertebrae in pigs. QTLs on SSC1 and SSC7 independently influenced the numbers of thoracic and lumbar vertebrae. These results shed light on the complex genetic background of vertebrae development in pigs.
文摘BACKGROUND Indirect decompression is one of the potential benefits of anterior reconstruction in patients with spinal stenosis.On the other hand,the reported rate of revision surgery after indirect decompression highlights the necessity of working out prediction models for the radiographic results of indirect decompression with assessing their clinical relevance.AIM To assess factors that influence radiographic and clinical results of the indirect decompression in patients with stenosis of the lumbar spine.METHODS This study is a single-center cross-sectional evaluation of 80 consecutive patients(17 males and 63 females)with lumbar spinal stenosis combined with the instability of the lumbar spinal segment.Patients underwent single level or bisegmental spinal instrumentation employing oblique lumbar interbody fusion(OLIF)with percutaneous pedicle screw fixation.Radiographic results of the indirect decompression were assessed using computerized tomography,while MacNab scale was used to assess clinical results.RESULTS After indirect decompression employing anterior reconstruction using OLIF,the statistically significant increase in the disc space height,vertebral canal square,right and left lateral canal depth were detected(Р<0.0001).The median(M)relative vertebral canal square increase came toМ=24.5%with 25%-75%quartile border(16.3%;33.3%)if indirect decompression was achieved by restoration of the segment height.In patients with the reduction of the upper vertebrae slip,the median of the relative increase in vertebral canal square accounted for 49.5%with 25%-75%quartile border(2.35;99.75).Six out of 80 patients(7.5%)presented with unsatisfactory results because of residual nerve root compression.The critical values for lateral recess depth and vertebral canal square that were associated with indirect decompression failure were 3 mm and 80 mm2 respectively.CONCLUSION Indirect decompression employing anterior reconstruction is achieved by the increase in disc height along the posterior boarder and reduction of the slipped vertebrae in patients with degenerative spondylolisthesis.Vertebral canal square below 80 mm2 and lateral recess depth less than 3 mm are associated with indirect decompression failures that require direct microsurgical decompression.
文摘Objective To investigate surgical strategy for high-grade isthmic spondylolisthesis(more thanⅡ degree)of 5th lumbar vertebrae.Methods From August 2003 to October 2008,26 patients with high-grade isthmic spondylolisthesis (L5) were
基金Supported by National Natural Science Foundation of China(Regional Program),No.82060879,No.82360947Gansu Province Key Talent Project,No.2024-4+2 种基金Natural Science Foundation of Gansu Province,No.20JR10RA356Gansu Provincial Joint Research Fund,No.23JRRA1534National Administration of Traditional Chinese Medicine High Level Key Discipline Construction Project of Traditional Chinese Medicine(Traditional Chinese Orthopedics and Traumatology Science),No.203.
文摘BACKGROUND This reported procedure combines the orthopedic surgical robot with the unilateral biportal endoscopy-lumbar interbody fusion(UBE-LIF),utilizing the UBE's wide viewing field and operating space to perform minimally invasive decompressive fusion of the lesioned segment,and the orthopedic surgical robot's intelligence and precision to perform percutaneous pedicle screw placement.The advancement of this procedure lies in the superposition of advantages and offsetting disadvantages of the two new technologies,and the maximum effect of treatment is achieved with maximum minimization of invasiveness and precision under the monitoring of imaging instruments to maximize the benefit of patients,and this review reports a case of multiple-segment lumbar decompression and fusion surgery for lumbar disc herniation via robot-assisted UBE for reference.CASE SUMMARY A 44-year-old patient presented to our hospital.Combining various clinical data,we diagnosed the patient with lumbar disc herniation with radiculopathy,lumbar spondylolisthesis,and lumbar spinal stenosis.We developed a surgical plan of"UBE decompression+UBE-LIF+orthopedic surgery robot-assisted percutaneous pedicle screw implantation for internal fixation".The results were satisfactory.CONCLUSION We present an extremely rare case of multiple-segment lumbar decompression and fusion surgery for lumbar disc herniation via robot-assisted UBE and achieved good results.Therefore,the technique is worthy of clinical promotion.
文摘BACKGROUND Lumbar disc herniation(LDH)commonly occurs during spinal surgery;LDH is on the increase in younger patients and is classified as"paralysis"and"back pain."Sanhanchushi Tongbi(SPST)is a customized prescription.It disperses cold,relieves pain,removes cold from the meridians and viscera,and treats neuropathic pain.However,few studies have investigated its mechanism of pain relief.AIM To observe the clinical therapeutic effects on LDH treated with self-prescribed SPST.METHODS A total of 211 patients with LDH syndrome were divided into two groups:107 patients in the control group were treated with conventional massage combined with traction,and 104 patients in the observation group were treated with a combination of the control regimen and self-prescribed oral SPST.The patients were treated for 4 wk.Indices of traditional Chinese medicine(TCM)syndrome score and serum inflammatory factor levels were measured.RESULTS After therapy,the TCM syndrome score in the observation group was significantly lower than that in the control group(P<0.05).The main symptoms,clinical signs,daily activities,and Japanese Orthopedic Association scores in the observation group were significantly higher than those in the control group after therapy(P<0.05).The levels of tumor necrosis factor-α,interleukin-6,and C-reactive protein were lower in the observation group than in the control group(P<0.05).In the observation group,superoxide dismutase levels were significantly higher,whereas malondialdehyde levels were significantly lower,compared with the control group(P<0.05).The overall efficacy rate in the observation group was 96.15%,which was substantially higher than that in the control group(88.79%;P<0.05).CONCLUSION Self-prescribed SPST can reduce the levels of inflammatory and pain-causing factors as well as lumbar pain in patients with LDH.
文摘AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back pain.METHODS: The review process applied systematic evidence-based assessment methodology of controlled trials of diagnostic validity and randomized controlled trials of therapeutic efficacy. Inclusion criteria encompassed all facet joint interventions performed in a controlled fashion. The pain relief of greater than 50% was the outcome measure for diagnostic accuracy assessment of the controlled studies with ability to perform previously painful movements, whereas, for randomized controlled therapeutic efficacy studies, the primary outcome was significant pain relief and the secondary outcome was a positive change in functional status. For the inclusion of the diagnostic controlled studies, all studies must have utilized either placebo controlled facet joint blocks or comparative local anesthetic blocks. In assessing therapeutic interventions, short-term and long-term reliefs were defined as either up to 6 mo or greater than 6 mo of relief. The literature search was extensive utilizing various types of electronic search media including Pub Med from 1966 onwards, Cochrane library, National Guideline Clearinghouse, clinicaltrials.gov, along with other sources includingprevious systematic reviews, non-indexed journals, and abstracts until March 2015. Each manuscript included in the assessment was assessed for methodologic quality or risk of bias assessment utilizing the Quality Appraisal of Reliability Studies checklist for diagnostic interventions, and Cochrane review criteria and the Interventional Pain Management Techniques- Quality Appraisal of Reliability and Risk of Bias Assessment tool for therapeutic interventions. Evidence based on the review of the systematic assessment of controlled studies was graded utilizing a modified schema of qualitative evidence with best evidence synthesis, variable from level Ⅰ to level Ⅴ.RESULTS: Across all databases, 16 high quality diagnostic accuracy studies were identified. In addition, multiple studies assessed the influence of multiple factors on diagnostic validity. In contrast to diagnostic validity studies, therapeutic efficacy trials were limited to a total of 14 randomized controlled trials, assessing the efficacy of intraarticular injections, facet or zygapophysial joint nerve blocks, and radiofrequency neurotomy of the innervation of the facet joints. The evidence for the diagnostic validity of lumbar facet joint nerve blocks with at least 75% pain relief with ability to perform previously painful movements was level Ⅰ, based on a range of level Ⅰ to Ⅴ derived from a best evidence synthesis. For therapeutic interventions, the evidence was variable from level Ⅱ to Ⅲ, with level Ⅱ evidence for lumbar facet joint nerve blocks and radiofrequency neurotomy for long-term improvement(greater than 6 mo), and level Ⅲ evidence for lumbosacral zygapophysial joint injections for short-term improvement only.CONCLUSION: This review provides significant evidence for the diagnostic validity of facet joint nerve blocks, and moderate evidence for therapeutic radiofrequency neurotomy and therapeutic facet joint nerve blocks in managing chronic low back pain.
文摘Percutaneous Transforaminal Endoscopic Discectomy is a minimally invasive surgery with little pain, less blood loss, less hospital stay and the surgery can be done in local anesthesia, which was started during late 20th century. Kambin and Gellmann in 1973 in the United States and Hijikata in Japanin 1977 individually preformed posterolateral percutaneous nucleotomy for the resection of the nucleus pulposus and release of compressed exiting nerve root, which is now spreading through the world and many surgeons are developing their skill but it needs experience and patience for successful outcomes. Along with advanced instruments now the surgery can be performed only giving a small skin incision of 8 - 10 mm and is as effective as the conventional method of surgery and open microdiscectomy surgery for the treatment of symptomatic lumbar disc herniation. In this review, we are explaining the technique of minimally invasive Percutaneous Transforaminal Endoscopic Discectomy surgery along its advantages and complications which can be encountered while performing this technique.
文摘Background: Pneumatic arterial tourniquet is a utilized strategy in limb surgeries to provide bloodless field to facilitate surgical procedure. Be that as it may, arterial tourniquet has numerous injurious impacts including hemodynamic changes and tourniquet-induced pain which sometimes can be severe and intolerable. Objectives: Our primary aim was to assess the impact of performing “Lumbar Plexus Block and sciatic nerve block” with General Anesthesia (GA) on the degree of arterial tourniquet-induced hemodynamic effects. On the other hand, our secondary aims were: amount of postoperative analgesic prerequisites, patient satisfactory score and documented side effects. Settings and Design: Ain Shams University, Orthopedic operating theatre;a prospective, randomized, double-blind study. Methods and Material: The physical status of 50 patients (both sexes) including I and II patients from American Society of Anesthesiologists, whose ages are from 20 - 40 years, is not so ideal when they are undergoing elective knee Arthroscopy. The duration lasts no more than ninety minutes under GA with application of tourniquet. Patients were allotted haphazardly to one of two groups. In Group C (Control group): Only GA. In Group B: LPB and sciatic nerve block were performed just before GA administration. Intraoperative hemodynamics was recorded at specific timings. Results: Incidence of tourniquet induced hypertension (TIH) was markedly less with Group B at: forty five, sixty, seventy five mins after tourniquet inflation and just before tourniquet deflation. Also, the total ketorolac consumption during first 24 hours of postoperative period was significantly less with Group B (p Conclusions: Combined Sciatic-Lumbar plexus blocks when combined with general anesthesia were very effective in attenuating TIH.
文摘目的探讨后路椎弓根螺钉内固定加椎体间BAK融合手术治疗低度(Ⅰ~Ⅱ度)腰椎滑脱症的临床与放射学结果的变化.方法行椎弓根螺钉内固定加椎体间融合器BAK融合者共26例.峡部不连性18例,退变性8例.L4滑脱14例、L5滑脱12例.测量所有患者的术前、术后、最后一次随访的站立位侧位x线片,测量项目包括腰椎曲线指数(index of 1umbarspinal curvature,LCI)、L4、5、L5S1节段前凸角、全腰椎前凸角.结果排除1例未融合数据,术后融合节段的节段前凸角明显改善,且经随访后无明显丢失.术前、术后、随访时全腰椎前凸角与LCI的差别无显著性意义.结论后路椎弓根螺钉内固定加椎体间BAK融合治疗腰椎滑脱症可以有效改善并维持腰椎的正常生理曲线.
文摘Introduction: Even though lumbar puncture (LP) represents an important tool in the diagnosis of certain neurological diseases, this procedure is little practiced by our students. We aimed to evaluate the attitudes and practices of students, interns, and residents about LP, and to assess their feelings about how this procedure is taught. Materials and Methods: We conducted a cross-sectional study of 160 participants, using an anonymous questionnaire, to evaluate the attitudes and practices of students, interns and residents in the pediatrics department concerning lumbar puncture. Results: Half of the participants had never performed LP, usually because of the risk involved or lack of confidence, while 20% had performed it more than 4 times. None of the participants had learned to perform the procedure through simulation sessions, while (42%) had learned it under the supervision of a senior physician and had not been able to perform it successfully the first time. Most participants inform the patient about the procedure before performing it. Only 44% of participants acknowledged that LP can be performed under local anesthetic. The sitting position (60%) was by far the most commonly used. Most LPs were performed for diagnostic purposes. Most participants stated that the pediatric ward and the pediatric emergency department are among the departments that perform LP most frequently, and that they would be interested in taking part in simulated lumbar puncture sessions in children in the future. Conclusion: The results of our study show that LP is perceived by students as a risky procedure that is difficult to perform. Teachers should reconsider how this technical procedure is taught, by integrating simulation on mannequins into student training.
基金supported by the 2022 study on the effectiveness of Fire Dragon Cupping in treating cold-dampness obstructive type shoulder stiffness,funded by the Bao'an District Healthcare Research Project in Shenzhen(Shen Bao Ke[2023]No.13,Project No.2022JD237)2023 study on the therapeutic observation and mechanism exploration of Fire Dragon Cupping in cold-dampness obstructive type acute gout,funded by the Guangdong Provincial Administration of Traditional Chinese Medicine(Yue Zhong Yi Han[2023]No.205,Project No.20242077)+1 种基金National Clinical Key Specialty(Traditional Chinese Medicine)Construction Project(2013-239)Sanming Project of Medicine in Shenzhen(No.SZZYSM202206014).
文摘Background:The incidence of lumbar disc herniation(LDH)is notably high.Consensus among experts highlights non-surgical treatments as the primary therapeutic approach for LDH.Contemporary medicine frequently employs pharmacotherapy and epidural injections in such treatments,which are associated with numerous adverse effects.Prolonged use can severely impair the liver and kidney functions of patients.Hence,the role of safe and effective traditional Chinese medicine techniques becomes pivotal.Among various traditional Chinese medicine approaches for treating LDH,fire dragon cupping,renowned for its remarkable efficacy,cost-effectiveness,and ease of application,is extensively utilised in clinical settings for managing LDH.Nonetheless,there is a scarcity of systematic and standardised evidence from evidence-based medicine studies.Therefore,conducting a meta-analysis is imperative.Methods:A comprehensive computerised search was conducted in databases including China National Knowledge Infrastructure,WanFang Data,VIP,China Biology Medicine disc,PubMed,EMbase,The Cochrane Library,Web of Science,and CINAHL.The search aimed to gather randomised controlled trials on fire dragon cupping therapy for LDH,spanning from the inception of these databases until December 2023.Two researchers independently screened the literature according to inclusion and exclusion criteria,extracted data,and assessed the methodological quality of the studies included,utilising RevMan 5.3 software for meta-analysis.Results:The results show that the fire dragon cupping therapy group had better clinical effectiveness(relative risk=1.23,95%confidence interval(CI)(1.14,1.33),P<0.00001),less pain(standardized mean difference=–1.33,95%CI(–1.49,–1.16),P<0.00001),and some improvement in lumbar function(Japanese Orthopaedic Association scores:mean difference=3.37,95%CI(2.31,4.43),P<0.00001.Conclusion:The fire dragon cupping therapy significantly alleviates LDH,warranting its extensive application.However,considering the limitations in the number and quality of studies included,the aforementioned conclusion necessitates further validation through more high-quality research.
文摘BACKGROUND Lumbar radiculopathy spondylosis is a relatively common orthopedic disease with a high incidence rate.It most commonly occurs in the lumbar 4-5 and lumbar 5-sacral 1 vertebrae,which account for approximately 95%of cases.It mostly occurs in people aged 30-50 years old and greatly affects their quality of life.AIM To determine the effect of triple-voltage acupuncture combined with helium-neon laser irradiation on the quality of care and improvement of symptoms in patients with lumbar radiculopathy spondylolisthesis.METHODS In this study,we selected 120 patients with lumbar radiculopathy spondylosis who were treated at our hospital between June 2019 to June 2020.The patients were divided into control and observation groups according to the random number table method,with 60 patients in each group.Patients in the observation group were treated with three-volt moxibustion combined with helium-neon laser irradiation,and those in the control group were treated with lumbar traction.After 1 month of treatment,the lumbar pain scores,lumbar spine motor functions,clinical treatment effects,and nursing satisfaction of the two groups were compared.RESULTS The results showed that acupuncture combined with laser irradiation significantly improved the patients'clinical symptoms,i.e.,reduced their low back pain,significantly lower numerical rating scale pain scores in the observation group than in the control group,and better lumbar spine motility than in the control group,compared to lumbar traction.In addition,they were cared for.The treatment effectiveness rate of the observation group was 95.5%,which was significantly higher than that of the control group(81.67%).Satisfaction with care was higher than 90 points in both groups,but the difference was not statistically significant.CONCLUSION Our study provides a clinical rationale for the future treatment of patients with lumbar spine disease.However,further extensive research is needed for validation.