腰部的脊骨的磁性的回声成像上的过渡 lumbosacral 解剖的预言

AIM:To evaluate two simple angle measurements for predicting lumbosacral transitional vertebra(LSTV) in magnetic resonance imaging(MRI) studies of the spine.METHODS:The lumbar spine MRI studies of 50 subjects with LSTV and 50 subjects with normal lumbosacral anatomy were retrospectively evaluated.In each study,the mid-sagittal T2-weighted image was used to measure the angle formed by a line parallel to the superior surface of the sacrum and a line perpendicular to the axis of the scan table(A-angle),as well as the angle formed by a line parallel to the superior endplate of the L3 vertebra and a line parallel to the superior surface of the sacrum(B-angle).RESULTS:The total study population consisted of 100 subjects(46 males,54 females,51 ± 16 years old).There were no differences in age and sex between the two groups.Both A-angle and B-angle were significantly increased in subjects with LSTV compared to controls(P 【 0.05).The optimal cut-off values of A-angle and B-angle for the prediction of LSTV were 39.8°(sensitivity = 80%,specificity = 80%,accuracy = 83%;95% confidence interval = 74%-89%,P = 0.0001) and 35.9°(sensitivity = 80%,specificity = 54%,accuracy = 69%;95% confidence interval = 59%-78%,P = 0.0005),respectively.CONCLUSION:On sagittal MR images of the lumbar spine,an increased A-angle and/or B-angle should alert the radiologist to the presence of LSTV.

Incremental value of magnetic resonance neurography of Lumbosacral plexus over non-contributory lumbar spine magnetic resonance imaging in radiculopathy: A prospective study

AIM: To test the incremental value of 3T magnetic resonance neurography(MRN) in a series of unilateral radiculopathy patients with non-contributory magnetic resonance imaging(MRI).METHODS: Ten subjects(3 men,7 women; mean age54 year and range 22-74 year) with unilateral lumbar radiculopathy and with previous non-contributory lumbar spine MRI underwent lumbosacral(LS) plexus MRN over a period of one year. Lumbar spine MRI performed as part of the MRN LS protocol as well as bilateral L4-S1 nerves,sciatic,femoral and lateral femoral cutaneous nerves were evaluated in each subject for neuropathy findings on both anatomic(nerve signal,course and caliber alterations) and diffusion tensor imaging(DTI)tensor maps(nerve signal and caliber alterations).Minimum fractional anisotropy(FA) and mean apparent diffusion coeffcient(ADC) of L4-S2 nerve roots,sciatic and femoral nerves were recorded.RESULTS: All anatomic studies and 80% of DTI imaging received a good-excellent imaging quality grading. In a blinded evaluation,all 10 examinations demonstrated neural and/or neuromuscular abnormality corresponding to the site of radiculopathy. A number of contributory neuropathy findings including double crush syndrome were observed. On DTI tensor maps,nerve signal and caliber alterations were more conspicuous. Although individual differences were observed among neuropathic appearing nerve(lower FA and increased ADC) as compared to its contralateral counterpart,there were no significant mean differences on statistical comparison of LS plexus nerves,femoral and sciatic nerves(P > 0.05).CONCLUSION: MRN of LS plexus is useful modality for the evaluation of patients with non-contributory MRI of lumbar spine as it can incrementally delineate the etiology and provide direct objective and non-invasive evidence of neuromuscular pathology.

Surgical treatment of sacral fractures following lumbosacral arthrodesis: Case report and literature review

Sacral fractures following posterior lumbosacral fusion are an uncommon complication. Only a few case series and case reports have been published so far. This article presents a case of totally displaced sacral fracture following posterior L4-S1 fusion in a 65-yearold patient with a 15-year history of corticosteroid use who underwent open reduction and internal fixation using iliac screws. The patient was followed for 2 years. A thorough review of the literature was conducted using the Medline database between 1994 and 2014. Immediately after the revision surgery, the patient's pain in the buttock and left leg resolved significantly. The patient was followed for 2 years. The weakness in the left lower extremity improved gradually from 3/5 to 5/5. In conclusion, the incidence of postoperative sacral fractures could have been underestimated, because most of these fractures are not visible on a plain radiograph. Computed tomography has been proved to be able to detect most such fractures and should probably be performed routinely when patients complain of renewed buttock pain within 3 mo after lumbosacral fusion. The majority of the patients responded well to conservative treatments, and extending the fusion construct to the iliac wings using iliac screws may be needed when there is concurrent fracture displacement, sagittal imbalance, neurologic symptoms, or painful nonunion.

THE SIGNIFICANCE OF DERMATOMAL SOMATOSENSORY EVOKED POTENTIALS IN THE DIAGNOSIS OF LUMBOSACRAL NERVE ROOT COMPRESSION

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VALUE OF MOTOR EVOKED POTENTIALS BY MAGNETIC STIMULATION IN DIAGNOSIS OF LUMBOSACRAL RADICULOPATHY

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ELECTRODIAGNOSIS OF LUMBOSACRAL RADICULOPATHY

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Intraneural ganglion cyst of the lumbosacral plexus mimicking L5 radiculopathy:A case report

BACKGROUND Intraneural ganglion cysts are benign gelatinous masses that form within the epineurium of a peripheral nerve.Only few cases of intraneural ganglion cyst arising from the hip joint have been reported.CASE SUMMARY A previously healthy 65-year-old woman who had been experiencing left buttock pain radiating to the dorsum of the foot for 2 years visited our clinic.Prior to visiting the clinic,she underwent lumbar spine magnetic resonance imaging and received physiotherapy,pain killers,and epidural injections based on a presumptive diagnosis of spinal stenosis for 2 years in other hospitals.Repeat magnetic resonance imaging revealed joint connection of the articular branch of the hip joint and rostral extension of the cyst along the L5 spinal nerve near the L5-S1 neural foramen.The patient was diagnosed with intraneural ganglion cyst arising from the articular branch of the hip joint based on high-resolution magnetic resonance neurography.Using the arthroscopic approach,a cystic opening within the intra-articular space was detected,and cyst decompression was then performed.The pain in the left leg was significantly relieved during the 6-mo follow-up.CONCLUSION Although intraneural ganglion cysts arising from the hip joint are rare,they can cause typical radicular pain and mimic common L5 radiculopathy.Typical cyst ascent phenomenon starting from the termination of the articular branch on magnetic resonance imaging is a crucial finding indicative of intraneural ganglion cysts arising from the hip joint.

THE SIGNIFICANCE OF LUMBOSACRAL RADICULOGRAPHY

One hundred and twenty-three lumbosacral radiculography in 67 patients, with age range from 15 to 60 years, have been performed during 1984-1986. In this paper, the anatomical concept of the lumbosacral (L4, 5 and S1) nerve root canal and the technique of radiculography are reported. Basing on our results. we suggest different pathologic images of the nerve root canal. The indication and failing causes in performing radiculography are discussed. We believe that nerve root block would be of great diagnostic and therapeutic value in cases of lumbago and sciatica.

Unilateral Reference Values for Hoffmann’s Reflex in Patients with Suspected Lumbosacral Radiculopathies

Unilateral reference values for Hoffmann’s amplitude could be applied to the diagnosis of lumbosacral radiculopathy, especially in patients with bilateral lesions. Here, we assessed Hoffmann’s reflex by measuring H-wave amplitude and the ratio of H-wave amplitude to M-wave amplitude (the H/M ratio). We performed a cross-sectional survey of patients from a Taiwan rehabilitation center (n = 64, age 20 - 87) who presented with lower back pain that radiated to the leg and received a referral for electrodiagnostic examinations. Reference values for H-wave profile parameters were determined using data from lumbosacral radiculopathy-negative patients (n = 10, age 22 - 53), who had normal big toe test results, ankle reflex test results, motor and sensory nerve conductive studies and F-wave latency and who displayed no evidence of radiculopathy in electromyography and imaging studies. The 50th percentile values for H/M ratio and H-wave amplitude were 28% and 6.25 mV, respectively. An H-wave profile th percentile (H/M ratio bosacral radiculopathy (n = 64). Approximately 41% of patients with an H-wave profile th percentile showed electromyography-confirmed chronic radiculopathy. Electromyography-confirmed current radiculopathy was observed in 35% of patients with an H/R

The Effect of Active Knee Extension in Sitting on Lumbopelvic Curvature in Individuals with Clinically Tight Hamstring Muscles: A Cross-Sectional Reliability Study

Relative flexibility between the hamstring and lumbar extensor muscles, which can be evaluated using lumbopelvic curvature during active knee extension in sitting, can sometimes be assessed in physical therapy. However, reliability for its quantitative measure has not been established yet and its establishment was the aim of the current study. Twenty-seven individuals with clinically tight hamstring muscles were recruited. On two separate sessions, the lumbopelvic curvature was evaluated in sitting when the right knee was moved from 90&deg flexion to 10&deg flexion on 15 occasions using a flexible ruler by two examiners on Day 1 and one on Day 2. Lines drawn tangential to the lumbopelvic curvature were traced at T12 and S2 vertebral levels and the angle between the two vertical lines was calculated. Using Day 1 data, the minimum number of repetitions and inter-examiner reliability were assessed. Inter-session reliability was also examined. As a result, there was no statistical difference (P?> 0.05) in the mean absolute difference between the mean value of N-1 and N repetitions (6 ≤ N ≤ 15) in the lumbopelvic curvature angle, indicating that five was considered the minimum number of repetitions. Intraclass correlation coefficient (ICC)(1, 5)?for the inter-session reliability and ICC(2, 5)?for the inter-examiner reliability was 0.97 and 0.93, respectively, indicating excellent reliability. The measure for the lumbopelvic curvature during active knee extension in sitting, which was established in the current study, will be a foundation for further research regarding the relative flexibility of the lumbar and adjunct regions.

A novel technique for sacropelvic fixation using image-guided sacroiliac screws:a case series and biomechanical study

In this study, we sought to assess the safety and accuracy of sacropelvic fixation performed with image-guided sacroiliac screw placement using postoperative computed tomography and X-rays. The sacroiliac screws were placed with navigation in five patients. Intact specimens were mounted onto a six-degrees-of-freedom spine motion simulator. Long lumbosacral constructs using bilateral sacroiliac screws and bilateral S1 pedicle and iliac screws were tested in seven cadaveric spines. Nine sacroiliac screws were well-placed under an image guidance system(IGS);one was placed poorly without IGS with no symptoms. Both fixation techniques significantly reduced range of motion(P<0.05) at L5-S1. The research concluded that rigid lumbosacral fixation can be achieved with sacroiliac screws,and image guidance improves its safety and accuracy. This new technique of image-guided sacroiliac screw insertion should prove useful in many types of fusion to the sacrum, particularly for patients with poor bone quality,complicated anatomy, infection, previous failed fusion and iliac harvesting.

Measurement Reliability for Evaluating Lumbopelvic Curvature during Active Knee Extension in Sitting Using a Flexible Ruler in Individuals with Clinically Tight Hamstring Muscles: A Secondary Analysis

In a previous study, we established reliability of a method for determining the angle of lumbopelvic sagittal alignment during active knee extension in sitting (AKEiS) using a flexible ruler and image analysis software (2-point-Method). In addition to this method, a flexible ruler can also be used to measure lumbopelvic sagittal alignment without image analysis software. This study primarily aimed to investigate the minimum number of repetitions, inter-session reliability and inter-examiner reliability of two alternative methods of measurement in a secondary analysis of our previous study. A flexible ruler was used to measure lumbopelvic curvature during AKEiS when the knee reached 10° flexion from 27 individuals with clinically tight hamstring muscles and subsequently analyzed. Lumbopelvic sagittal alignment was evaluated for the region between T12 and S2 using the maximum depth to the curvature (Max-Method) or depth to the curvature at the middle point between T12 and S2 vertebral levels (Mid-Method). It was determined that four repetitions for the Max-Method and 11 repetitions for the Mid-Method were required for the minimum number of repetitions, respectively. Inter-session reliability and inter-examiner reliability were assessed using Intraclass Correlation Coefficients and were 0.91 and 0.91 for the Max-Method and 0.90 and 0.91 for the Mid-Method, respectively. The current study suggests that the Mid-Method would not be recommended for use in the clinical setting as 11 repetitions of data sampling is required. The 2-point-Method or Max-Method may be promising but the ideal measurement method will be identified when the validity of these methods has been established.

Concomitant Retroperitoneal Intramuscular Hemangioma and Intravascular Papillary Endothelial Hyperplasia: An Unusual Case Report

Primary retroperitoneal tumors are rare, and benign retroperitoneal tumors are exceptionally rare. Herein, we present a very rare case of benign concomitant retroperitoneal intramuscular hemangioma and intravascular papillary endothelial hyperplasia, with the unusual presentation of lumbosacral plexopathy. After surgical treatment and rehabilitation, the patient recovered uneventfully. This case report should serve to remind physicians of the rare condition of a retroperitoneal tumor leading to a neurological deficit.

针刺配合腰骶刺络放血治疗慢性前列腺炎

Objective:To observe the effect of acupuncture and bloodletting therapy at the lumbosacral region for chronic prostatitis.Methods:A total of 36 patients with chronic prostatitis were collected,and treated in the Department of Acupuncture and Moxibustion and the External Treatment Center of Chinese Medicine,Affiliated Hospital of Shandong University of Traditional Chinese medicine.The patients were treated with acupuncture,combined with bloodletting therapy at the lumbosacral region.The treatment for 4 weeks was as one course and 2 consecutive courses of treatment were required.The therapeutic effect,including the score of the National Institute of Health-Chronic prostatitis symptom index(NIH-CPSI),was assessed.Results:After 1 and 2 courses of treatment,the symptom scores and NIH-CPSI total score were all reduced as compared with that before treatment,respectively(all P<0.01).After 2 courses of treatment,the score of each symptom and NIH-CPSI total score were reduced as compared with that after 1 course of treatment,respectively(all P<0.01).Regrading the 3 syndromes/patterns of chronic prostatitis in the patients,i.e.downward invasion of damp heat,qi and blood stagnation and liver qi stagnation,after 1 and 2 courses of treatment,NIH-CPSI total scores were all reduced as compared with that before treatment(all P<0.01).Additionally,after 2 courses of treatment,NIH-CPSI total score of each syndrome/pattern was reduced as compared with that after 1 course of treatment(all P<0.01).For kidney yin deficiency,after 2 courses of treatment,NIH-CPSI total score was reduced as compared with that either before treatment or after 1 course of treatment(both P<0.01).The total effective rate was 91.67%after 1 course of treatment and 97.22%after 2 courses of treatment.No obvious adverse events occurred during the treatment.Conclusion:The combined treatment with acupuncture and bloodletting therapy at the lumbosacral region effectively relieves the symptoms of chronic prostatitis and improves the quality of life in the patients.

An integrative insight into the synsacral canal of fossil and extant Antarctic penguins

The lumbosacral-canal system in birds most likely operates as a sense organ involved in the control of balanced walking and perching,but our knowledge of it is superficial.Penguins constitute interesting objects for the study of this system due to their upright walking,but only the Humboldt penguin,Spheniscus humboldti,and some incomplete fossil penguin synsacra have been studied in this respect.Here,we give an integrative comparative in-sight into the synsacral canal of extant Emperor penguin,Aptenodytes forsteri,Adelie penguin,Pygoscelis adeliae,and Eocene giant Anthropornis and/or Palaeeudyptes Antarctic penguins,using computed tomography imaging and associated data-extraction methodologies,complemented by analytical approaches ranging from geometric morphometrics to modularity,curvature,and wavelet analyses.We document that the variability in the number of synsacro-lumbar vertebrae is evolutionarily conserved,and all studied synsacra possess osteological correlates of the lumbosacral-canal system.We also found that Eocene and extant Antarctic penguins were separable on the basis of the main direction of the shape-related(size-independent)variability within said system,and A.forsteri was unique in the entire studied set in terms of the relative cranial shift of this compound structure.Moreover,we suggest that the evolutionary processes,shaping both the terrestrial posture and gait,were responsible,in extant penguins,for the increased simplicity and stability of the synsacral canal cross-sectional periodic patterns,as well as pave the way for the lumbosacral-canal system modularity characterized by reduced atomization/complexity.

Using a consensus acupoints regimen to explore the relationship between acupuncture sensation and lumbar spinal postoperative analgesia: A retrospective analysis of prospective clinical cooperation

Objective: This study evaluated the effectiveness of acupuncture treatment on postoperative pain in patients with degenerative lumbar spine disease, and explored the relationship between the postoperative analgesic effect of acupuncture and the sensation of acupuncture experienced by the patients.Methods: This retrospective study analyzed the medical records of 97 patients who had undergone an operation by the same surgeon due to degenerative lumbar disease. These patients were divided into acupuncture group(n = 32), patient-controlled analgesia(PCA) group(n = 27), and oral analgesia group(n = 38) according to the different postoperative analgesic methods. During their hospitalization, patients completed daily evaluations of their pain using a visual analogue scale(VAS), and injection times of supplemental meperidine were recorded. Also, the Chinese version of the Massachusetts General Hospital Acupuncture Sensation Scale(C-MASS) was used in the acupuncture group.Results: Each of the three treatment groups showed significant reductions in postoperative pain, as shown by reduced VAS scores. The acupuncture group, however, had less rebound pain(P < 0.05) than the other two groups. Both the acupuncture and PCA groups experienced acute analgesic effects that were superior to those in the oral analgesia group. In addition, the higher the C-MASS index on the second day after surgery, the lower the VAS score on the fourth day after surgery. There was also a significant difference in the“dull pain” in the acupuncture sensation.Conclusion: The results demonstrated that acupuncture was beneficial for postoperative pain and discomfort after simple surgery for degenerative spinal disease. It is worth noting that there was a disproportionate relevance between the patient’s acupuncture sensation and the improvement of pain VAS score.