L5-S1 Level Research Articles

Ultrasonography of Lumbar Multifidus Muscle in University American Football Players.

The primary objective of this study was to examine and compare lumbar multifidus (LM) muscle size, asymmetry, and function in university football players with and without low back pain (LBP). A secondary objective was to examine the relationship between LM characteristics and body composition in football players. Ultrasound assessments of the LM muscle were performed in 41 university football players during the preseason. LM muscle cross-sectional area, echo intensity (e.g., indicator of fatty infiltration and connective tissue), thickness at rest, and thickness during submaximal contraction (e.g., contralateral arm lift) measurements in prone and standing positions were obtained bilaterally at the L5-S1 level. Body composition measures were acquired using dual-energy x-ray absorptiometry. A self-administered questionnaire was used to obtain LBP history data. The LM muscle thickness at rest in prone and in standing was significantly smaller in football players who reported the presence of LBP in the previous 3 months. The LM cross-sectional area in prone was significantly and positively correlated with weight, height, lean body mass, total fat mass, and total percent body fat. LM echo intensity was strongly correlated with total percent body fat and total fat mass and negatively correlated with the percent thickness change during contraction. The results of this study provide novel information on LM muscle morphology and activation in football players in prone and standing and suggest that players with LBP in the previous 3 months had smaller LM muscle thickness. LM morphology was strongly correlated with body composition measurements.

Endoscopic Unilateral Laminotomy with Bilateral Discectomy Using Biportal Endoscopic Approach: Technical Report and Preliminary Clinical Results

Bilateral or huge disc herniations cause bilateral radiculopathy and severe lower back pain. In such cases, a bilateral discectomy may be required to resolve the radicular pain in both legs. We attempted a surgical technique involving bilateral lumbar discectomy via a unilateral approach using a percutaneous biportal endoscopic technique. The purpose of the present study was to describe our surgical technique and investigate the clinical outcomes in symptomatic bilateral lumbar disc herniation. Eleven patients with bilateral disc herniation of the L4-L5 or L5-S1 segments were surgically treated using the percutaneous biportal endoscopic approach. Biportal endoscopic unilateral laminotomy with bilateral discectomy was performed in all patients. Postoperative magnetic resonance imaging was performed 1 day after surgery, and the clinical parameters were investigated preoperatively and postoperatively. All enrolled patients were successfully treated by biportal endoscopic bilateral discectomy via a unilateral approach. Surgery was performed at the L4-L5 level in 1 patient and the L5-S1 level in 10 patients. The mean operative time was 67.5 ± 13.1 minutes. A visual analog scale of leg pain and the Oswestry disability indexshowed significant improvement after surgery (P<0.05). Endoscopic unilateral laminotomy with bilateral discectomy using the percutaneous biportal endoscopic approach could be an effective and alternative treatment of symptomatic bilateral herniated disc disease affecting L4-L5 or L5-S1 segments.

Compression of the S1 Nerve Root by an Extradural Vascular Malformation: A Case Report and Discussion of Atypical Causes of Lumbar Radiculopathy

We present a case of lumbar radiculopathy due to a vascular malformation in the lumbar spine and discuss various causes of atypical lumbar radiculopathy. Lumbar radiculopathy is a condition of neurologic deficits and painful symptoms of the lower extremities due to nerve root compression, most commonly at the L5 and S1 levels. Several factors contribute to lumbar radiculopathy, including intervertebral disc herniation, foraminal stenosis, and spinal instability. There are also a number of atypical causes, including medication side effects or metabolic disorders, which produce symptoms of radiculopathy but do not involve compression of the nerve root. Anatomic variations in the nerve roots or vascular supply surrounding the nerve root may also increase the risk of developing radiculopathy and serve as an obstacle to interpreting imaging during a preoperative workup. A 38-year-old woman presented with sudden onset radicular symptoms in her right lower extremity. Lumbar magnetic resonance imaging demonstrated a right-sided L5-S1 extruded nucleus pulposus. Her symptoms failed to improve after conservative management so she underwent surgical decompression of L4-S1. Intraoperatively, we discovered an extensive, extradural vascular malformation present at the L5-S1 level and believed this to be the true cause of her radiculopathy. This case represents an atypical cause of lumbar radiculopathy and demonstrates the importance of considering atypical causes during diagnostic workup and preoperative planning.

Weak psoas and spine extensors potentially predispose to hip fracture.

We performed a computed tomography analysis of muscle composition characteristics in hip fracture patients and non-hip fracture controls. In total, 43 patients (9 men, 34 women) were included in the hip fracture group, matched 1 to 1 with non-hip fracture controls. Muscle cross-sectional areas were measured in axial CT scan at the body level of the 4th lumbar vertebra (L4), intervertebral disc level between the 5th lumbar vertebra and the 1st sacral vertebra (L5-S1) and just below level of the lesser trochanter (LT). Attenuation was also evaluated through the mean Hounsfield unit (HU) in these areas. The cross-sectional area per weight (CSA/Wt, mm2/kg) of psoas muscle and extensor muscles of the spine showed a significant difference between the 2 groups at both L4 (9.7 vs. 12.4, p < 0.001 and 26.3 vs. 29.2, p = 0.025) and L5-S1 (9.6 vs. 11.5, p = 0.001 and 8.8 vs. 10.3, p = 0.041) levels. In addition, the HU of these muscles differed significantly between the 2 groups at both L4 (33.3 vs. 47.6, p < 0.001 and 13.7 vs. 30.2, p < 0.001) and L5-S1 (39.7 vs. 52.6, p < 0.001 and 3.8 vs. 15.1, p = 0.012) levels. There was no difference in abdominal wall, gluteal, or thigh compartment musculature between the groups. Poorer quantity and quality of psoas muscle and extensor muscles of the spine rather than whole body muscles may contribute to falls and were characteristic features of the hip fracture patients in this series. These findings should be considered when recommending a preventive exercise and rehabilitation protocol.

Magnetic resonance imaging findings of redundant nerve roots of the cauda equina

BACKGROUNDRedundant nerve roots (RNRs) of the cauda equina are often a natural evolutionary part of lumbar spinal canal stenosis secondary to degenerative processes characterized by elongated, enlarged, and tortuous nerve roots in the superior and/or inferior of the stenotic segment. Although magnetic resonance imaging (MRI) findings have been defined more frequently in recent years, this condition has been relatively under-recognized in radiological practice. In this study, lumbar MRI findings of RNRs of the cauda equina were evaluated in spinal stenosis patients.AIMTo evaluate RNRs of the cauda equina in spinal stenosis patients.METHODSOne-hundred and thirty-one patients who underwent lumbar MRI and were found to have spinal stenosis between March 2010 and February 2019 were included in the study. On axial T2-weighted images (T2WI), the cross-sectional area (CSA) of the dural sac was measured at L2-3, L3-4, L4-5, and L5-S1 levels in the axial plane. CSA levels below 100 mm2 were considered stenosis. Elongation, expansion, and tortuosity in cauda equina fibers in the superior and/or inferior of the stenotic segment were evaluated as RNRs. The patients were divided into two groups: Those with RNRs and those without RNRs. The CSA cut-off value resulting in RNRs of cauda equina was calculated. Relative length (RL) of RNRs was calculated by dividing the length of RNRs at mid-sagittal T2WI by the height of the vertebral body superior to the stenosis level. The associations of CSA leading to RNRs with RL, disc herniation type, and spondylolisthesis were evaluated.RESULTSFifty-five patients (42%) with spinal stenosis had RNRs of the cauda equina. The average CSA was 40.99 ± 12.76 mm2 in patients with RNRs of the cauda equina and 66.83 ± 19.32 mm2 in patients without RNRs. A significant difference was found between the two groups for CSA values (P < 0.001). Using a cut-off value of 55.22 mm2 for RNRs of the cauda equina, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) values of 96.4%, 96.1%, 89.4%, and 98.7% were obtained, respectively. RL was 3.39 ± 1.31 (range: 0.93-6.01). When the extension of RNRs into the superior and/or inferior of the spinal canal stenosis level was evaluated, it was superior in 54.5%, both superior and inferior in 32.8%, and inferior in 12.7%. At stenosis levels leading to RNRs of the cauda equina, 29 disc herniations with soft margins and 26 with sharp margins were detected. Disc herniation type and spondylolisthesis had no significant relationship with RL or CSA of the dural sac with stenotic levels (P > 0.05). As the CSA of the dural sac decreased, the incidence of RNRs observed at the superior of the stenosis level increased (P < 0.001).CONCLUSIONRNRs of the cauda equina are frequently observed in patients with spinal stenosis. When the CSA of the dural sac is < 55 mm2, lumbar MRIs should be carefully examined for this condition.

Differences in lumbar segment angle among Roussouly types of global sagittal alignment in asymptomatic adult subjects.

A radiological study. To examine lumbar segment angle according to the Roussouly type of global sagittal alignment and to determine the reference disc angles in minimally invasive surgery (MIS) for adult spinal deformity. Optimal restoration of lumbar lordosis (LL) in adult spinal deformity surgery includes achieving the ideal shape of LL as well as the amount of LL. However, the distribution of lumbar segment angles by the Roussouly type has yet to be elucidated. Forty sets of whole spine lateral radiographs covering the four Roussouly types (N = 160) were obtained from a database of asymptomatic adult subjects. Global and spinopelvic parameters were measured. Disc and vertebral angles at each lumbar level were compared among the Roussouly types. There were 75 (46.9%) men with a mean age of 32.8 ± 8.9years among the total of 160 study subjects. A significant difference was found in spino-sacral angle, sacral slope, pelvic incidence, LL, and lower arc of LL (L4S1) among the Roussouly types (all P < 0.001). The ratio of the lower arc of LL (L4S1) to LL was 83.4% in Roussouly type 1, 65.2% in type 2, 64.7% in type 3, and 61.5% in type 4. The disc angles at the L1-2 and L2-3 levels in Roussouly type 1 were significantly smaller than in the other types. The disc angle at the L5-S1 level in Roussouly type 1 was significantly larger than that in type 2. Roussouly type 4 had a larger disc angle at the L2-3 and L4-5 levels than types 1 and 2. The results of this study showed that the disc angle distribution differs among Roussouly types. The configuration of LL as well as the amount of LL should be considered in adult spinal deformity surgery. Level IV.

Spinal sagittal alignment goals based on statistical modelling and musculoskeletal simulations

The definition of target alignment for spinal fusion surgery follows anatomical criteria and strongly relies on surgical experience. However, the optimal patient-specific alignment often remains unknown. Statistical models could provide information about physiological alignments, and musculoskeletal models are powerful tools to investigate biomechanics. We aimed to statistically predict alignments and hypothesized they would be biomechanically favorable.A statistical model was trained with 60 annotated radiographs to predict physiological sagittal alignment based on position of femoral heads and sacrum. Predicted alignments for 11 back pain patients were clinically evaluated in terms of balance and compared to Original alignments. The normative ranges for spinal balance parameters were obtained from Surgimap™. Musculoskeletal loads were furthermore simulated in upright standing and 30° forward flexion, using alignment-specific musculoskeletal models.For the majority of Predicted alignments (n = 9) at least two of three investigated balance parameters were within the normative range, as opposed to the minority of the Original alignments (n = 4). Predicted alignments resulted in significantly lowered overall muscle activity and compressive loads (all levels, both postures). Shear force magnitudes in upright standing decreased significantly at levels L1L2 (−68 N) and L2L3 (−69 N) and clearly yet not significantly at L3L4 (−39 N) and L4L5 (−152 N). Shear loads at level L5S1 remained the same. In flexed postures identical trends were observed.The statistical model was able to predict spinal alignments that led to both improved balance and reduced musculoskeletal loads. Further studies are needed to investigate clinical validity of such models.

Magnetic Resonance Evaluation of Lumbar Disc Degenerative Disease as an Implication of Low Back Pain: A Prospective Analysis.

The main objectives of this study are MR characterization of disc degeneration and sequelae, analysis of lumbar disc degeneration patterns in patients with low back pain, and evaluation of the extent of involvement. This unique study evaluates the number of discs involved and the Modic changes at prolapsed, degenerated nonprolapsed, and at nondegenerated, nonprolapsed levels. A prospective, magnetic resonance imaging-based radiological study. A total of 1000 whole spine and lumbosacral spines were subjected to MRI examination, including spin echo with T1, T2, and STIR sequences. The Modic classification, Pfirrmann disc classification method, Borenstein criteria for central spinal canal stenosis, and Weishaupt Classification for Facet Degeneration were used for evaluation. The commonest level of disc degeneration was L4-L5 (41.2%) and the commonest type was disc protrusion (69.4%). Disc height reduction was common at L5-S1 level (32.2%). Multidisc involvement is the commonest presentation (38.2%) followed by contiguous double level (34.7%) with disc bulges frequently reported at L3-L4 (27.2%) and L4-L5 (26.9%) levels. Majority of discs (56.1%) demonstrated Modic changes at prolapsed levels. Spondylolisthesis was commonly reported at L5-S1 level (87.5%) and was mostly associated with lumbar canal stenosis (38.4%). Posterior osteophytes were frequent at L3-L4 (31.1%) and L5-S1 (31.1%) levels. D12-L1 was least affected (4.1%) in lumbar disc degenerative disease. The clinicians evaluated multiple variables associated with intervertebral disc degeneration and its sequelae such as lumbar canal stenosis and found the evaluation methods to be simple and practical in evaluating lumbar spine degeneration and simple communication.

Risk factors predicting less favorable outcomes in endoscopic lumbar discectomies.

Endoscopic lumbar discectomy was among the first minimally invasive spine procedures commonly performed. As such, all the benefits of minimal invasion were seen, including less pain, less soft tissue destruction, and faster recovery. While outcomes compare favorably to micro and open discectomy, not all patients fare equally well. This paper examines independent risk factors to assess their correlation to suboptimal outcomes after endoscopic lumbar discectomy. Retrospective analysis of clinical outcomes of 55 consecutive patients treated with endoscopic discectomy between June 2018 and March 2019 by the author. Primary outcome measures were postoperative reductions of visual analog score (VAS) for back and leg pain modified MacNab criteria as well as time to narcotic independence. Risk factors examined included smoking, facet disease, adjacent segments disc degeneration, obesity, alcohol abuse, and psychiatric illness. There were 31 males and 24 females with a mean age of 41.76±12.53. Most patients suffered from contained herniations (49.1%) followed by extruded herniations (18.2%). Follow-up ranged from 6-18 months. The most common surgical levels were L5-S1 level (30.9%), L4-S1 (29.1%), and L4-5 (25.5%). The mean return to work (RTW) was 23.83±26.01 weeks. The average body mass index (BMI) was 29.11±4.75. The average time for narcotic independence was 9.64±7.29 days. MacNab outcomes showed that 47.3% (26/55) had excellent, 36.4% good (20/55), 12.7% fair (7/55), and 3.6% had poor (2/55), respectively. The VAS scores for the back (7.69 to 2.65) and leg (6.78 to 2.65) pain reduced significantly (P<0.0001). Smoking (P=0.048), psychiatric disease (P=0.029), disc herniations larger than 10 mm, facet disease, obesity (BMI >30), diabetes, and alcohol abuse was associated with fair and poor MacNab outcomes. Endoscopic lumbar discectomy safely and reliably reduces axial pain and radiculopathy from lumbar disc herniations. Risk factors associated with incomplete pain relief are large herniations, obesity, instability, smoking, advanced facet degeneration, and decreased ability to cope with the surgery.

Suprailiac versus transiliac approach in transforaminal endoscopic discectomy at L5-S1: a new surgical classification of L5-iliac crest relationship and guidelines for approach.

Approach to the L5-S1 level with transforaminal access can be challenging. Some surgeons employ the interlaminar or paraspinal endoscopic approach as an alternative apart from the other minimally invasive posterior surgical options. To precisely target and safely access disc herniations at L5-S1, the authors attempted to stratify patients into trans and supra iliac approach groups and propose a simple surgical classification based on the radiographic findings. A prospective study was performed on a cohort of 90 patients with L5-S1 disc herniation who underwent transforaminal endoscopic discectomy through suprailiac or transiliac approach depending on the best trajectory to access the herniated disc. Preoperative radiological assessment was done on anteroposterior and lateral radiographs of the lumbosacral spine by two independent observers. The proposed classification and approach guidelines were used to stratify patients for the preferred access route. The outcome was measured as mean VAS and ODI scores pre-operative and at 6 months post-operative and compared using the null hypothesis (P value) and the paired t-test. The interrater reliability was calculated as the percentage agreement between different observers. The L5-S1 disc herniation was treated with the transforaminal approach in 46 patients via the suprailiac and in the remaining 44 patients via the transiliac approach. There were statistically significant VAS and ODI reductions in patients of both groups (P<0.05). Interrater reliability of 92.5% using percent agreement shows strong level of agreement. This surgical approach classification based on radiographs aids in the preoperative planning for selection of patients to either suprailiac or transiliac approach for transforaminal endoscopic surgery at L5-S1 level.

Change in the dimensions of the lumbar area muscles after surgery: MRI analysis.

OBJECTIVE:This study aims to assess the change in the dimensions of the lumbar muscles in patients with chronic lower back pain using Magnetic Resonance Imaging (MRI) and to determine pre/post effects of surgery.METHODS:We enrolled 28 individuals (13F/15M; age: 45.39±11.56 years) whose L2–S1 muscle measurements were obtained using MRI, before and at follow-up 6–12 months after surgery. The control group comprising 37 individuals (18F/19M; age: 34.41±10.72 years) who had no lumbar pathology but for whom retrospective archive images were available. In the axial MRI analysis, the cross-sections of m.multifidus, mm.erector spinae and m.psoas major on both sides were measured with the ‘closed polygon’ technique.RESULTS:The L2–3 and L4–5 levels of the m.multifidus on the right side, the L2–3, L4–5 and L5–S1 levels of the m.multifidus and the L5–S1 levels of the mm. erector spinae on the left side cross-sectional areas were significantly lower than the control group (p<0.05). The right-side m.multifidus and the left-side mm.erector spinae sectional areas were significantly lower than the pre-surgery values at the L5–S1 levels (p<0.05).CONCLUSION:This study demonstrated that chronic lower back pain causes atrophy in the lumbar muscles and established the existence and continuity of atrophy after surgery.

Which is the most affected muscle in lumbar back pain – multifidus or erector spinae?

IntroductionThe purpose of this study is to evaluate the relationship between lumbar back pain, lumbar disc herniation, and erector spinae and multifidus muscle lipomatous degeneration.Material and methodsAfter receiving approval from the clinical studies Ethics Committee, magnetic resonance imaging (MRI) studies of patients who had physical examination in orthopaedic, neurology, neurosurgery, physical medicine and rehabilitation clinics were evaluated. Their pre-diagnoses were ‘herniated nucleus pulposus’ or ‘lumbar disc herniation’ or ‘back pain’ and their age range was between 18 and 64 years. Patients who had vertebral fracture, spondylitis-spondylodiscitis, tumours, structural anomalies such as spondylolisthesis, scoliosis and vertebral segmentation anomalies and previous surgery in the lumbar area were excluded. There were 205 patients in the case group who had lumbar disc herniation between L1-S1 level and there were 187 patients in the control group who had no lumbar disc herniation. In the study, patient age, sex, herniation level and erector spinae and multifidus muscle lipomatous degeneration were compared. Muscle lipomatous degeneration were evaluated with a visual scale.ResultsThere were 105 men and 100 women in the case group and 88 men and 99 women in the control group. In the case group, lumbar disc herniation was detected mostly at L4-5 and L5-S1 levels. There was no significant difference between case and control groups with regard to erector spinae and multifidus muscle lipomatous degeneration. In the case group, lipomatous degeneration of the erector spinae was higher compared to that of the multifidus muscle.ConclusionsPatients with low back pain may have fatty degeneration in erector spina and multifidus muscles with or without LDH, but LDH accelerates this process rather than being a result of it. In patients with LDH, fatty degeneration in the erector spina is more pronounced than in multifidus, and the erector spina is more affected by the LDH process.

Endoscopic Untethering of Tight Filum Terminale: An Operative Technique.

To demonstrate the various technical advantages of minimally invasive endoscopic untethering of tight filum terminale for the treatment of tethered cord syndrome (TCS). In five pediatric cases of TCS, we performed untethering by using the endoscopic technique. The age of the patients were 6, 7, 8, 9, and 12 years old. We used a nasal speculum of the transsphenoidal approach during the endoscopic surgical procedure. All the procedures were performed uneventfully, except for one case with a split cord malformation that showed neurologic deterioration caused by excision of the diastematomyelic fibrous septum at the thoracic level (unrelated to the endoscopic procedure at the L5-S1 level). This patient was referred to a rehabilitation clinic 5 days after surgery and showed significant improvement by the third postoperative month. The other four patients were discharged 1 day after the operation. Endoscopic release of filum terminale is a safe technique especially if it is performed with neuromonitoring. This technique may shorten the length of hospital stay and reduce perioperative blood loss. However, futher studies with a larger number of patients and long-term follow-up are needed.

Predictive factors for treatment success of transforaminal epidural steroid injection in lumbar disc herniation-induced sciatica

Background/aim The aim of this study was to identify predictive factors for treatment success in transforaminal epidural steroid injection in patients with lumbar disc herniation-induced sciatica. Materials and methods A total of 219 patients who were diagnosed with unilateral sciatica and underwent transforaminal epidural steroid injections at the level of L4-5, L5-S1, or S1 neural foramina between March 2016 and May 2018 were retrospectively analyzed. The presence of transitional vertebrae and the grade of nerve root compression were evaluated by a radiologist. Data including age, sex, body mass index, duration of symptoms, injection levels, and pain scores were recorded. Pain scores were evaluated using the numerical rating scale. Treatment success was defined as a ≥50% decrease in pain scores at 3 months.Results The study included 118 female and 101 male patients with a mean age of 43.65 ± 12.18 years. The mean duration of symptoms was 25.64 ± 2.17 weeks. Although the duration of symptoms was longer in patients for whom treatment failed, it did not reach statistical significance. Decreased pain scores at 1 h had a significant effect on treatment success (p = 0.012, odds ratio (OR): 1.015, 95% confidence interval (CI), 1.003–1.026).ConclusionsOur study results suggest that a decreased pain score at 1 h is a predictor for a favorable three-month response to transforaminal epidural steroid injection in patients with lumbar disc herniation-induced sciatica.

An Ayurvedic Approach to Prolapsed Intervertebral Disc (Gridhrasi)

This case study exemplifies the efficacy of Ayurvedic medications and procedures in the management of prolapsed intervertebral disc (PIVD), where disc bulge with nerve impingement at L5-S1 was diagnosed radiologically. A 24-year-old patient presented to the OPD of Dept. of Kayachikitsa, Ch. Brahm Prakash Ayurved Charak Sansthan, New Delhi, with complaints of severe low back pain radiating to the bilateral lower limb, rendering him unable to do his day-to-day activities. The pain started 8 months back, but the intensity of pain became severe in the last 1 month so much so that he had to rely upon others to do his routine activities and this brought about considerable financial impact also. This case was diagnosed as PVID or lumbar disc herniation at the L5-S1 level based on the magnetic resonance imaging (MRI) report. The patient was treated with Panchakarma procedures and Ayurvedic oral drugs and got satisfactory results with no side effects. The visual analog scale (from 9 to 0), Oswestry disability index (from 58% to 17%), SLR (from 35° left and 30° right to 90° in bilateral limbs), ESR (from 45 to 8), and MRI report were considered as parameters of assessment. Sustained and satisfactory improvement was noted at the follow-up after 2 months and protrusion of disc was resolved during treatment. After the course of treatment, the pain was completely resolved during the walking or rest condition and during the follow-up period, he also resumed his work with no disquiet. This case study validates that PIVD can be successfully treated with the Ayurvedic treatment modality.

The isthmic corridor- a novel anatomical approach for L5-S1 postero-lateral endoscopic lumbar discectomy (PELD)

BackgroundLumbosacral junction (L5-S1) with its distinctive anatomical features, presents a unique challenge to endoscopic spine surgeons.1–7 The choice between interlaminar and postero-lateral (transforaminal) routes for L5-S1 endoscopic discectomy remains controversial. PurposeDescribe a novel isthmic approach for postero-lateral endoscopic lumbar discectomy (PELD) at L5-S1 level and critically analyze the surgical results. Study DesignTechnical note. Case series. Patient Sample25 patients with symptomatic L5-S1 disc herniation. Outcome MeasureDemographics, radiological features, bony anatomy, and clinical outcomes. MethodsEach patient underwent postero-lateral endoscopic lumbar discectomy utilizing isthmic approach. The patient data was prospectively collected and retrospectively analyzed. ResultsAverage pain score for back pain and leg pain significantly improved from pre-op level of 3.09 and 7.81 to 2.17 and 2.15, respectively. Statistically significant improvement was also observed in post-op ODI score (pre-op = 58, post-op 33.85, p ≤ 0.00001). There were no intra-op complications of nerve or thecal sac injury. ConclusionCombining isthmus trajectory to L5-S1 postero-lateral endoscopic discectomy adds to the applicability of this already well established surgical procedure. Isthmic approach offers a safe and effective anatomical corridor for performing endoscopic discectomy via transforaminal route, even in individuals with high iliac crest.

Clinical experience with paravertebral ozone and synthesis material withdrawal (transpedicular screws) [abstract

Clinical experience with paravertebral ozone and synthesis material withdrawal (transpedicular screws) [abstract

Prediction of the Spinal Musculoskeletal Loadings during Level Walking and Stair Climbing after Two Types of Simulated Interventions in Patients with Lumbar Disc Herniation.

Background Low back pain (LBP) continues to be a severe global healthy problem, and a lot of patients would undergo conservative or surgical treatments. However, the improving capacity of spinal load sharing during activities of daily living (ADLs) after interventions is largely unknown. The objective of this study was to quantitatively predict the improvement of spinal musculoskeletal loadings during level walking and stair climbing after two simulated interventions. Material and Methods Twenty-six healthy adults and seven lumbar disc herniation patients performed level walking and stair climbing in sequence. The spinal movement was recorded using a motion capture system. The experimental data were applied to drive a musculoskeletal model to calculate all the lumbar joint resultant forces and muscle activities of seventeen main trunk muscle groups. Rehabilitation and reconstruction were selected as the representative of conservative and surgical treatment, respectively. The spinal load sharing after rehabilitation and reconstruction was predicted by replacing the patients' spine rhythm with healthy subjects' spine rhythm and altering the center of rotation at the L5S1 level, respectively. Results During both level walking and stair climbing, the joint resultant forces of the lower lumbar intervertebral discs were predicted to reduce after the two simulated inventions. In addition, the maximum muscle activities of the most trunk muscle groups decreased after simulated rehabilitation and conversely increased after simulated reconstruction. Conclusion The predictions revealed the different compensatory responses on the spinal load sharing after two simulated interventions, severing as guidance for making preoperative planning and rehabilitation planning.

Evaluation of functional outcome of microsurgical management of lumbar canal stenosis

Evaluation of functional outcome of microsurgical management of lumbar canal stenosis - IJN- Print ISSN No: - 2581-8236 Online ISSN No:- 2581-916X Article DOI No:- 10.18231/j.ijn.2019.040, IP Indian Journal of Neurosciences-IP Indian J Neurosci

Spinopelvic Alignment Parameters in Spondylolisthesis Patients Compared to Nonspondylolisthesis Patients

Abstract Objective We aimed at describing spin pelvic alignment features in patients with degenerative spondylolisthesis (DS), in comparison with other patients complaining of low back pain but no evidence of spondylolisthesis on standard standing lateral lumbosacral X-ray. Methods In this prospective descriptive study, patients with low back pain included in two groups of DS and non-DS patients, according to preoperative lumbosacral X-ray in standard standing lateral position. Patient’s demographic characteristics, as well as spinopelvic alignment parameters including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis, and facet joint orientation, were collected. DS patients were compared with non-DS, age-matched control group. Results DS patients were significantly obese (p = 0.031) and had a high PI (56.39 ± 11.5), SS (38.28 ± 10.32), and PT (18.52 ± 9.11), (p = 0.00, 0.01, 0.04, respectively). Moreover, segmental lordosis at L2–L3, L3–L4, and L5–S1 levels demonstrated a significant increase (p &lt; 0.05). Facet joints at L4–L5 level were located more sagittally (37.5 ± 7.07 vs. 40.71 ± 6.33). Conclusion PI, SS, and PT significantly increase in DS patients compared with non-DS group. Elevated segmental lordosis at high lumbar levels and sagittal orientation of facet joints were other features observed in DS patients.