Lumbar Spinous Processes Research Articles

A novel frameshift deletion variant of ARSL associated with X-linked recessive chondrodysplasia punctata 1: a case report and literature review of prenatal, confirmed cases

BackgroundX-linked recessive chondrodysplasia punctata 1 (CDPX1) is a rare congenital skeletal dysplasia characterized by stippled epiphyses, nasal hypoplasia, and brachytelephalangy. ARSL (formerly known as ARSE), a member of the sulfatase gene family located on Xp22.3, has been identified as the causative gene for CDPX1. The high clinical and genetic heterogeneity of CDPX1 presents a challenge to prenatal diagnosis.Case presentationA G1P0 woman in her 30s with an unremarkable prenatal course presented in the second trimester. Maternal diseases, tobacco, alcohol, and drug history during pregnancy were denied. Obstetrical ultrasound examination revealed a flattened nose and a flattened midface with echogenic alterations of lumbar spinous process in the fetus. Amniocentesis was performed for genetic testing. A normal karyotype and a negative result of CNV-seq were obtained. However, Whole exome sequencing (WES) in trios revealed a hemizygous ARSL variant [NM_000047.3:c.1108del p.(Trp370Glyfs*35)] in the fetus, which was maternally inherited as confirmed by Sanger sequencing. This variant was absent from the genomAD and HGMD databases. According to the ACMG guidelines, this variant was interpreted as likely pathogenic (PVS1 + PM2_Supporting). The couple decided to terminate the pregnancy. After induction of labour, a severe nasal hypoplasia was noted; and brachytelephalangy was not remarkable. Postmortem digital X-ray imaging revealed symmetrical stippled epiphyses of the vertebrae in all spine regions and enlargement of spinous process of L1-L4 vertebrae.ConclusionA novel frameshift deletion variant of ARSL and the associated fetal phenotype have been identified. This study provides useful information for prenatal diagnosis and genetic counseling of CDPX1.

ULTRASOUND MEASUREMENT OF THE VERTEBRAL LEVEL OF TUFFIERS LINE IN ELDERLY WOMEN (A COMPARITIVE CROSS SECTIONAL STUDY)

Background:Sometimes , generalizing the vertebral level which is determined by palpation in patients across all the age groups may be inaccurate. This study has aimed to compare the vertebral level intersected by the Tuffiers line in elderly women versus adult womenutilizing an ultrasound in the left lateral decubitus flexed position, to provide a more precise understanding of the potential age-related differences . Methods:We enrolled 50 female patients over the age of 65 (elderly group) and 50 female patients between ages 20-50 (control group) who had been scheduled to undergo surgeries under spinal Anaesthesia. Using ultrasound, we marked the L2–L5 lumbar spinous processes and intervertebral spaces. The most cephalad part was labeled as 1 and the most caudal part was labeled 11. We then identified to which line of these vertebral levels Tuffiers line crossed using an ultrasound. Results:In the elderly group, the median vertebral level of Tuffiers line was found to be located at L2-L3 (median value = 3), whereas in the control group, it was situated at the lower part of L4 (median value = 8). Moreover, asignificant correlation was found between the vertebral level of Tuffiers line and age, weight and BMI in the elderly group (P < 0.001), indicating a significant association between these factors. Conclusions:The ultrasound measurement in the left lateral decubitus flexed position revealed that the Tuffiers line was situated more cranially (towards the head) in elderly women compared to the control group. This indicates that the needle may inserted at a higher level than anticipated, indicating the importance of careful level determination during spinal Anaesthesia in elderly women to avoidcomplications.

Three-dimensional analysis of puncture needle path through safety triangle approach PLD and design of puncture positioning guide plate.

In this study, the three-dimensional relationship between the optimal puncture needle path and the lumbar spinous process was discussed using digital technology. Additionally, the positioning guide plate was designed and 3D printed in order to simulate the surgical puncture of specimens. This plate served as an important reference for the preoperative simulation and clinical application of percutaneous laser decompression (PLD). The CT data were imported into the Mimics program, the 3D model was rebuilt, the ideal puncture line N and the associated central axis M were developed, and the required data were measured. All of these steps were completed. A total of five adult specimens were chosen for CT scanning; the data were imported into the Mimics program; positioning guide plates were generated and 3D printed; a simulated surgical puncture of the specimens was carried out; an X-ray inspection was carried out; and an analysis of the puncture accuracy was carried out. (1) The angle between line N and line M was 42°~55°, and the angles between the line M and 3D plane were 1°~2°, 5°~12°, and 78°~84°, respectively; (2) As the level of the lumbar intervertebral disc decreases, the distance from point to line and point to surface changes regularly; (3) The positioning guide was designed with the end of the lumbar spinous process and the posterior superior iliac spine on both sides as supporting points. (4) Five specimens were punctured 40 times by using the guide to simulate surgical puncture, and the success rate was 97.5%. By analyzing the three-dimensional relationship between the optimal puncture needle path and the lumbar spinous process, the guide plate was designed to simulate surgical puncture, and the individualized safety positioning of percutaneous puncture was obtained.

Static palpation ain't easy: Evaluating palpation precision using a topographical map of the lumbar spine as a reference.

Clinicians commonly use manual therapy to treat low back pain by palpating the spine to identify the spinous processes. This study aims to evaluate the ability of experienced clinicians to consistently locate the spinous processes from S1 to T12 through palpation. The results will be compared to topographical data representing the lumbar lordosis at baseline and four follow-up time points. In a prior prospective randomized trial, experienced clinicians used palpation to locate the lumbar spinous processes (S1-T12) and then digitized these locations in three-dimensional space. The same digitizing equipment was then used to continuously collect three-dimensional position data of a wheel that rolled along the back's surface through a trajectory that connected the previously digitized locations of the spinous processes. This process was repeated at 4 days, 1, 4, and 12 weeks. The resulting lordosis trajectories were plotted and aligned using the most anterior point in the lordosis to compare the locations of the spinous processes identified in different trials. This way, spinous palpation points could be compared to surface topography over time. Intra- and interrater reliability and agreement were estimated using intraclass correlations of agreement and Bland-Altman limits of agreement. Five clinicians palpated a total of 119 participants. The results showed a large degree of variation in precision estimates, with a mean total value of 13 mm (95%CI = 11;15). This precision error was consistent across all time points. The smallest precision error was found at L5, followed by S1 File, after which the error increased superiorly. Intra- and interrater reliability was poor to moderate. Comparison of palpation results to a topographic standard representing the lumbar lordosis is a new approach for evaluating palpation. Our results confirm the results of prior studies that find palpation of lumbar spinous processes imprecise, even for experienced clinicians.

The influence of body painting on L4 spinous process palpation accuracy in novice palpators

ABSTRACT Objectives Current literature remains inconclusive regarding the best methodology to accurately palpate lumbar spinous processes (SP). Body painting (BP) uses markers to draw anatomical structures on the skin’s surface. While BP can be a useful tool for engaging learners, it is unknown whether it improves palpation accuracy. The purpose of this study was to investigate whether the addition of body painting to palpation education improves lumbar spinous process palpation accuracy in first-year Doctor of Physical Therapy (DPT) students. Methods Thirty-eight DPT students were randomized into a traditional palpation group and a body painting (BP) group. Each group received identical instruction on palpating the lumbar spine, with the BP group additionally drawing lumbar SPs on their laboratory partner with a marker. Students were then assessed on their ability to accurately palpate the L4 SP on randomly assigned subjects. Two Certified Registered Nurse Anesthetists (CRNAs) used ultrasound imaging to confirm the location of each student’s palpation. Palpation time was also recorded. The BP group also completed a survey on the learning experience. Results Forty-five percent of students were able to accurately palpate the L4 SP. There was no significant difference (p = 0.78) in palpation accuracy between the traditional and BP group, although students in the BP group were randomly assigned subjects with a significantly (p = 0.005) higher BMI. Ninety-five percent of students were able to palpate within one spinal level of the L4 SP. Students in the BP group reported that the BP activity facilitated learning and active participation. There was no significant difference in palpation time (p = 0.98) between groups. There was a fair correlation (r=-0.41) between palpation accuracy and subject BMI. Discussion/Conclusion While body painting was an enjoyable activity to incorporate into palpation laboratory, it is unclear whether it enhanced lumbar SP palpation accuracy in first-year DPT students.

Correlation between spinous process deviation and lumbar disc herniation in young patients

To explore the relationship between spinous process deviation and lumbar disc herniation in young patients. From March 2015 to January 2022, 30 treated young (under the age of 30) patients with lumbar disc herniation were included as the young group. In addition 30 middle-aged patients (quinquagenarian group) with lumbar disc herniation and 30 patients with non-degenerative spinal diseases (young non-degenerative group) were selected as control groups. The angle of the spinous process deviation was measured on CT and statistically analyzed by various groups. All the data were measured twice and the average value was taken and recorded. The average angle of spinous process deviation in the degenerative lumbar vertebra of young patients were (3.89±3.77) degrees, similar to the (3.72±2.98) degrees of quinquagenarian patients(P=0.851). The average angle of s spinous process deviation young non-degenerative group were (2.20±2.28) degrees, significantly less than young group(P=0.040). The spinous process deviation angle of the superior vertebral of the degenerative lumbar in the young group was (4.10±3.44) degrees, which similar to the (3.47±2.87) degrees in the quinquagenarian group (P=0.447). A total of 19 young patients had the opposite deviation direction of the spinous process of the degenerative lumbar vertebra and upper vertebra, while only 7 quinquagenarian patients had this condition(P=0.02). The type of lumbar disc herniation in young patients had no significant relationship with the direction of spinous process deflection of the degenerative or upper lumbar vertebra (P>0.05). Spinous process deviation is a risk factor of young lumbar disc herniation patients. If the deviation directions of adjacent lumbar spinous processes are opposite, it will increase the incidence of lumbar disc herniation in young patients. There was no significant correlation between the type of disc herniation and the deviation direction of the spinous process of the degenerative or upper lumbar vertebra. People with such anatomical variation can strengthen the stability of spine and prevent lumbar disc herniation through reasonable exercise.

Duration of Electro-Dry Needling Does Not Change the Pain Response After Repeated Nociceptive Thermal Stimuli in Asymptomatic Individuals: A Randomized Intervention Study

ObjectiveTo assess the effects of 5 different durations of electro-dry needling (EDN) on asymptomatic individuals’ pain response after repeated noxious thermal stimuli. DesignRandomized, non-controlled intervention trial. SettingUniversity laboratory. ParticipantsAsymptomatic participants (N=50) were recruited for the study and randomized into 5 groups. There were 33 women with an average age of 26.8 (±4.8) years. To participate in the study, individuals had to be between the ages of 18 and 40, free of any musculoskeletal injury which prevented participation of daily activities, and not pregnant or trying to become pregnant. InterventionsParticipants were randomly assigned to receive 5 different durations of EDN: 10, 15, 20, 25, and 30 minutes. To perform the EDN, 2 monofilament needles were inserted lateral to the lumbar spinous processes of L3 and L5 on the right. Needles were left in situ with electrical stimulation at a frequency of 2 Hz and an amplitude which resulted in a 3 to 6 out of 10 intensity pain rating by the participant. Main Outcome MeasuresThe change in the magnitude of pain in response to repetitive heat-pulses before and after the EDN procedure. ResultsThere was a significant reduction in the magnitude of pain in response across the groups after EDN (F(1,42)=94.12, P<.001, ƞp2=.691). However, the interaction between time and group was not significant (F(4,42)=1.019, P=.409, ƞp2=.088), indicating that no duration of EDN was superior to another in reducing temporal summation. ConclusionsThis study suggests that in asymptomatic individuals, performing EDN beyond 10 minutes does not provide any additional benefits in the reduction of the magnitude of pain in response to thermal nociceptive stimuli. Additional study in symptomatic populations is required for generalizability in clinical settings.

The effect of lifting load on the kinematic characteristics of lumbar spinous process in vivo

BackgroundThere are limited data on the in vivo natural kinematics of the lumbar spinous process. This paper intends to explore the effect of lifting load on the in vivo movement mode of the lumbar spinous process and its biomechanical changes.MethodsTen asymptomatic subjects between the ages of 25 and 39 underwent CT scans of the lumbar spine in the supine position, and 3D models of L3-L5 were constructed. Using a Dual Fluoroscopy Imaging System (DFIS), instantaneous orthogonal fluoroscopic images of each subject's flexion–extension, left–right bending, and left–right rotational movements were taken under different loads (0 kg, 5 kg, 10 kg). The supine CT model was matched, using computer software, to the bony contours of the images from the two orthogonal views, so that the instantaneous 3D vertebral position at each location could be quantified. A Cartesian coordinate system was ultimately constructed at the tip of the spinous process to obtain the 6DOF kinematic data of the spinous process.ResultsIn different postural movements of the trunk, there was no significant difference in the rotation angle and translation range of the lumbar spinous process under different loads (P > 0.05). In flexion to extension motion, spinous processes mainly rotate < 4° along the medial and lateral axes and translate < 4 mm along the craniocaudal direction. In the left–right bending motion, spinous processes mainly rotate < 5° along the anterior and posterior axes, and the translation is mainly coupling < 2 mm. In the rotational motion, the spinous process is mainly coupled motion, the rotation range is less than 3°, and the translation range is less than 2 mm. The distance between spinous processes measured in the supine position was 6.66 ± 2.29 mm at L3/4 and 5.08 ± 1.57 mm at L4/5.ConclusionThe in vivo kinematics of the lumbar spinous process will not change significantly with increasing low load. In complex motion, the spinous process is dominated by coupling motion.

Immediate Effect of Mulligan’s Spinal Mobilization with Limb Movements on Straight Leg Raise Test in Patients with Lumbar Radiculopathy: A Randomized Controlled Trial

Context: Lumbar radiculopathy is pain which starts from the lumbar spine and radiates to one or both lower limbs. Spinal mobilization with limb movement (SMWLM) has been proposed for the treatment of lumbar radiculopathy by Brian Mulligan. Studies on SMWLM have found it to have positive effect in reducing radicular symptoms, but a comparative study of SMWLM versus sham mobilization is lacking to prove the beneficial effect of SMWLM since sham procedures more clearly differentiate the efficacy of an intervention. Aims: To compare the immediate effect of SMWLM with sham SMWLM on straight leg raise (SLR) and Visual Analog Scale (VAS) in patients with lumbar radiculopathy. Settings and Design: Single-blinded randomized controlled trial. Subjects and Methods: Twenty-eight participants with lumbar radiculopathy (mean age 40.2 ± 12.2 years) were included. The trial group (n = 14) received SMWLM and control group (n = 14) received sham SMWLM. In SMWLM a transverse glide was applied with the therapist thumb just lateral to the involved lumbar spinous process and the hip was taken into flexion. Sham SMWLM was given by placing thumb just lateral to the involved spinous process without applying any glide while the limb was taken into only 10° of hip flexion. The pre- and immediate post-SLR test angle and VAS was compared within each group and postvalues was compared between the two groups. Statistical Analysis: The data were analyzed with Wilcoxon’s signed-rank test and Mann–Whitney U-test. Results: Post intervention in the experimental group there was a significant increase in SLR test angle (P = 0.001) and reduction in VAS (P = 0.001) while in the control group only VAS decreased (P = 0.034). There was a significant difference between the groups in postintervention SLR test angle (P = 0.038) and VAS (P = 0.018). Conclusion: Through its biomechanical, neurophysiological effects, and marginal placebo effects, SMWLM can be used as an effective treatment technique for immediate improvement in pain-free SLR range in patients with lumbar radiculopathy.

Quantitative Anatomic Analysis and Clinical Application of Lumbar Spinous Process Split Laminotomy.

To investigate the feasibility and safety of lumbar spinous process split laminotomy by quantitative anatomic analysis. Nine fresh adult human cadaveric specimens (including 45 lumbar segments) were divided into 3 groups randomly. The simulated operations and anatomic measurements were performed to evaluate the visibility angle and surgical corridor at different retraction widths (8 mm, 10 mm, and 12 mm). By measuring the width causing bony fracture in 45 lumbar segments, the safety margin of retraction width was determined. The findings of lumbar spinous process split laminotomy in one typical case were presented. At 8 mm retraction width, there was not enough surgical corridor for the operation procedures. At 10 mm and 12 mm retraction width, all operation procedures could be conducted smoothly. The 12 mm group presented a larger surgical corridor and shorter operative time compared with the 10 mm group. The imaging examination confirmed no bony fracture and articular capsule impairment. The visibility angle and exposure extent increased in proportion to the retraction width. The retraction width that resulted in the bony fracture ranged from 12.34 mm to 16.82 mm, with an average of (14.56 ± 1.73) mm. The positions of fracture were in the pedicle of the vertebral arch (68.9%), the lamina (26.7%), and the vertebral body (4.4%). The retraction width of 10 mm-12 mm is safe and effective. The micromanipulations such as tumor resection, nervous exploration, dural suture, etc. can be conducted smoothly via the surgical corridor. In addition, the retraction width of 12.34~16.82 mm could serve as a safety margin for surgical planning. Our findings may provide a quantitative reference for clinical application of lumbar spinous process split laminotomy.

Feasibility and improvement of a three-dimensional printed navigation template for modified cortical bone trajectory screw placement in the lumbar spine.

Compared with traditional pedicle screw trajectory, cortical bone trajectory (CBT) increases the contact surface between the screw and cortical bone where the screw is surrounded by dense cortical bone, which does not deform remarkably due to degeneration. We aimed to provide detailed information about the improvement of three-dimensional (3D)-printed navigation templates for modified CBT screw placement in the lumbar spine and evaluate the safety and accuracy thereof. Four human cadaveric lumbar spine specimens were selected. After CT scanning data were reconstructed to 3D models, either the left or right side of each specimen was randomly selected to establish a 3D-navigation template, mutually complemented with the surface anatomical structure of the lateral margin of the lumbar isthmus, vertebral plate, and spinous process. The corresponding 3D centrum was printed according to the CT scanning data, and a navigation template of supporting design was made according to modified cortical bone technique. The same template was used to insert CBT screws into 3D printed and cadaveric specimens. After the screws were inserted, the screw path of the 3D printed specimens was directly observed, and that of the anatomical specimens was scanned by CT, to determine the position and direction of the screws to analyze the success rate of screw placement. Twenty cortical bone screws were placed in each of the 3D printed and anatomical specimens, with excellent rates of screw placement of 100% and 95%, respectively. We report the easy, safe, accurate, and reliable use of a 3D-printed navigation template to carry out screw placement by modified cortical bone technique in the lumbar spine.

A guide for standardized interpretation of lumbar multifidus ultrasonography; an observational study

BackgroundInconsistent descriptions of Lumbar multifidus (LM) morphology were previously identified, especially in research applying ultrasonography (US), hampering its clinical applicability with regard to diagnosis and therapy. The aim of this study is to determine the LM-sonoanatomy by comparing high-resolution reconstructions from a 3-D digital spine compared to standard LM-ultrasonography.MethodsAn observational study was carried out. From three deeply frozen human tissue blocks of the lumbosacral spine, a large series of consecutive photographs at 78 μm interval were acquired and reformatted into 3-D blocks. This enabled the reconstruction of (semi-)oblique cross-sections that could match US-images obtained from a healthy volunteer. Transverse and oblique short-axis views were compared from the most caudal insertion of LM to L1.ResultsBased on the anatomical reconstructions, we could distinguish the LM from the adjacent erector spinae (ES) in the standard US imaging of the lower spine. At the lumbosacral junction, LM is the only dorsal muscle facing the surface. From L5 upwards, the ES progresses from lateral to medial. A clear distinction between deep and superficial LM could not be discerned. We were only able to identify five separate bands between every lumbar spinous processes and the dorsal part of the sacrum in the caudal anatomical cross-sections, but not in the standard US images.ConclusionThe detailed cross-sectional LM-sonoanatomy and reconstructions facilitate the interpretations of standard LM US-imaging, the position of the separate LM-bands, the details of deep interspinal muscles, and demarcation of the LM versus the ES. Guidelines for electrode positioning in EMG studies should be refined to establish reliable and verifiable findings. For clinical practice, this study can serve as a guide for a better characterisation of LM compared to ES and for a more reliable placement of US-probe in biofeedback.

Variations of spinous and transverse process length in the human lumbar spine

ABSTRACT Background: Some manual therapy schools of thought rely on palpation of vertebral position via bony processes prior to the application of directional manual interventions. It is feasible that malformation or asymmetry of the spinous processes (SPs) or transverse processes (TPs), if unknown, may influence the outcome of a diagnostic palpatory exam and the application of directional manual interventions. This study provides morphometric data for the lumbar spine, to assess the occurrence of length differences in lumbar SPs and TPs occurring between the right and left sides. Methods: The lumbar processes were measured bilaterally in 16 adult cadaveric specimens, 9 females and 7 males ranging in age from 68 to 89 years. A measurable difference in SP length, defined as ≥ 0.1 cm, was found in 72.4% of the population, and for TP lengthin 90.6% of the population. A mean SP length difference of 0.2 ± 0.2 cm and a mean TP length difference of 0.4 ± 0.3 cm were observed. Process length was longer on average for males, and the magnitude of process length difference increased with age. Conclusion: These results indicate that a finding of a clinical positional fault of a vertebra through palpatory exam may be flawed.

Radiological Analysis of Minimally Invasive Microscopic Laminectomy for Lumbar Canal Stenosis with a Focus on Multilevel Stenosis and Spondylolisthesis

We retrospectively compared the radiological and clinical outcomes of two different surgical techniques (lumbar spinous process splitting laminectomy [LSPSL] and unilateral laminotomy for bilateral decompression [ULBD]) to treat lumbar spinal canal stenosis (LCS). We performed a retrospective comparative study of 141 consecutive patients with an average age of 70.8 ± 9.4 years who had undergone LSPSL or ULBD for LCS between April 2015 and April 2019. None of the patients had developed remote fractures of the spinous processes using either technique. These cases were divided into 2 groups: group L, 73 patients who had undergone LSPSL from April 2015 to April 2017; and group U, 68 patients who had undergone ULBD from May 2017 to April 2019. The clinical and radiological outcomes and surgical complications at the 1-year postoperative follow-up period were evaluated. We found no significant differences in the operative time between the 2 groups. However, group U had had significantly less blood loss than group L. The facet joints were significantly well preserved in group U. We examined the multilevel and spondylolisthesis cases separately and found that both surgical procedures were equally effective and that the visual analog scale scores for back or leg pain and Japanese Orthopaedic Association scores had significantly improved postoperatively in each group. Group U showed better outcomes in terms of LCS recurrence, with 3 patients in the group L requiring repeat surgery. We found both ULBD and LSPSL to be safe and effective techniques for LCS, even for patients with spondylolisthesis and multilevel disease. ULBD was superior in terms of recurrence prevention, preservation of the facet joints, and less blood loss.

Asymmetrical thoracic-lumbar coordination during trunk rotation between adolescents with and without thoracic idiopathic scoliosis.

Cross-sectional comparative study. To compare thoracic-lumbar kinematic changes and coordination based on coupling angles (CAs) in two different directions of trunk rotation between adolescents with idiopathic scoliosis (AIS) and control subjects. Altered three-dimensional (3D) deviations are often apparent in AIS groups during functional activities, such as gait. However, there is a lack of consistent evidence on coordinated motions during different directions of trunk rotation. This study included 14 AIS and 17 age-matched control subjects who were all right limb dominant. A motion capture system was utilized to analyze the spinal segment motions. The outcome measures included range of motion (ROM) at the first thoracic (T1), seventh thoracic (T7), and first lumbar (L1) spinous processes as well as the sacral tubercle (S1). The CAs compared in-phase (rotation from right to left) and anti-phase (rotation from left to right) trunk rotations. Although there was no significant association with the spinal segments in the control group, the Cobb angle demonstrated significant positive correlations with anti-phase at T7 and L1 as well as in-phase at L1. Regarding the CAs, the groups demonstrated a significant interaction with both phases (F = 4.7, p = 0.04). The AIS group demonstrated positive correlations with ROM during in-phase at L1 and anti-phase at T7 and L1. The coordination based on the CAs of the lumbar spine relative to the thoracic spine significantly decreased during left to right trunk rotation in the AIS group. These results indicated that the AIS group demonstrated directional dissociation toward the dominant side of lumbar rotation. III.

Investigation on bone fusion of spinous process in microscopic lumbar spinous process splitting laminoplasty using crossing suture method of lamina and spinous process for two spinous process

Investigation on bone fusion of spinous process in microscopic lumbar spinous process splitting laminoplasty using crossing suture method of lamina and spinous process for two spinous process

Effect of pediatric flat foot on the sagittal alignment of the pelvis and spine

Human body segments interact harmoniously and efficiently so that homeostasis is maintained in any circumstances. Even the slightest modification of the support surface can have repercussions on postural control strategies and consequently can lead to a change in the alignment of the whole body. Flat foot is the most common condition of the lower limb. It is clinically manifested on multiple anatomical planes: flattening of the medial longitudinal arch (sagittal plane), valgus of the calcaneus (frontal plane) and abduction of the anterior foot (transverse plane). In any case, the influence of structural modifications of the flat foot on one’s posture, especially in children, still remains an insufficiently researched topic. The purpose of this study was to assess the effects that structural modifications of a flat foot have on the pelvis and spine in the sagittal plane, in children aged 7-9. Thus, the following hypothesis was formulated: the structural modifications of flat feet can modify the sagittal alignment of the pelvis and spine in children aged 7-9. The flat feet were assessed using the Foot Posture Index-6 (FPT-6) while the sagittal alignment of the pelvis and spine was measured using the GPS-400 computerised postural analysis system. Statistical analysis of the data did not indicate any significant correlations between the FPI-6 score and pelvic tilt angle or between the FPI-6 score and differences between the sensors and the lumbar and dorsal spinous processes.

Predicting the Difficulty Score of Spinal Anaesthesia

Background: Spinal anaesthesia is the commonest regional anaesthesia conducted for several surgical procedures.&#x0D; Objectives: This study aims to predict the difficulty score of spinal anaesthesia to scale back the complications and ultimately improve anaesthesia quality.&#x0D; Materials and Methods: Patients undergoing various surgeries involving spinal anaesthesia were taken in this study and several parameters like demographic details, body mass index, spinous process condition were recorded pre operatively to see how they influenced the difficulty of performing spinal anesthesia on them.&#x0D; Results: Out of the 101 patients enrolled in this study, 53 underwent an easy SA by the first attempt in the first space. It was moderate in 36 and difficult in 12 patients.&#x0D; Conclusion: Considering the examination of patients with respect to BMI, lumbar spinous process status and deformities, radiological signs of lumbar vertebrae can be helpful in predicting how difficult the SA procedure is going to be.

A Radiological Evaluation of Lumbar Spinous Processes and Interspinous Spaces, Including Clinical Implications.

Background and objectiveThe aim of this study was the examination of morphometry of the spinous process (SP) and interspinous space (ISS) of the lumbar region to help provide a basis for the design and implantation of interspinous devices.MethodsBetween 2017 and 2019, 215 individuals underwent magnetic resonance imaging of the lumbar region for various reasons. No pathology was detected in these images, and the participants' age, height, and weight information when available were included in the study. From these images, the height and length of the SP and ISS in the lumbar region were noted. The heights of the SP and ISS were measured at three levels as anterior, middle, and posterior (respectively, anterior height of the spinous process [AHSP], middle height of the spinous process [MHSP], as well as posterior height of the spinous process [PHSP] for the height of SP, and anterior ISS, middle ISS and posterior ISS for the height of ISS). All measurements were compared according to the gender, age, weight, height, and body mass index of the individuals.ResultsThe level with the lowest SP height and length was L5 vertebra. The ISS height and length were lowest at L4-L5. In addition, we observed a statistically significant difference at multiple levels with age, weight, height, and body mass index of the reference ranges.ConclusionWe think that these changes should be considered when designing and implanting interspinous devices. Since there are few studies examining all these correlations, we think that the results of this study will make a unique contribution to the literature.

Assessing vertebral body rotation for percutaneous pedicle screw placement in scoliosis surgery

Study DesignRetrospective Review. ObjectiveThe aim of this study was to evaluate the incidence and magnitude of pedicle asymmetry as well as spinous process deviation in the healthy lumbar spine. Summary of Background DataMinimally invasive spine surgery relies on fluoroscopic imaging as bony landmarks used for instrumentation are not exposed. The precision of techniques used to determine vertebral body rotation intraoperatively may be confounded by anatomic variation or pathology. Here, we investigate the physiologic variation in different anatomic structures of the lumbar spine used for percutaneous pedicle screw placement. Methods100 normal lumbar CT scans, without evidence of acute deformity, significant spondylosis, scoliosis, or spondylolisthesis were reviewed to assess for pedicle height, width and spinous process angle (SPA) to compare symmetry between right and left sided pedicles for each vertebral body. Spinous process deviation of ≥5° in the axial plane was considered a relevant finding and the magnitude of offset from midline was calculated using the deviation angle and spinous process length. ResultsAnalysis of CT scans found that 17.5% of lumbar spinous processes had an average angular variation ≥5°. This calculates to a clinically significant 3.53 mm average offset of spinous processes from midline in 17.5% of lumbar vertebrae. Pedicle height and width measurements did not show statistically or clinically significant variation when comparing right to left lumbar pedicles. ConclusionThese results suggest that using the spinous process as a fluoroscopic landmark during intraoperative imaging to determine neutral rotation of lumbar vertebrae can be an unreliable technique. Rotational alignment can be determined more reliably by comparing left to right pedicle symmetry. These findings should be considered when selecting an operative technique to assess neutral vertebral alignment during percutaneous pedicle screw instrumentation.