Lumbosacral Region Research Articles

HUBUNGAN WHOLE BODY VIBRATION DENGAN DISABILITAS LOW BACK PAIN PADA PENGEMUDI OJEK

Background. Low Back Pain (LBP) is a syndrome that occurs in the waist precisely in the lumbosacral region of the spine and belongs to the group of work-related musculoskeletal disorders. It is estimated that around 43% of the entire Indonesian population experiences LBP. Whole Body Vibration (WBV) is a mechanical vibration produced by a vibrating field such as when a person drives. These vibrations can be transmitted throughout the body and become one of the risk factors for LBP disability, in addition to length of driving, age and Body Mass Index. The purpose of this study was to assess the relationship between WBV and NBP in online motorcycle taxi drivers. Method. This study used a cross-sectional design on 101 online motorcycle taxi drivers in the West Jakarta area. LBP disability data was obtained through filling out the Oswestry Dissability Index (ODI) questionnaire and measuring WBV was carried out with a vibration meter. The analysis was performed with a Chi-square test using SPSS version 27. Result. The age range of respondents is between 20-60 years with the largest population in the age range of 31-40 years (38.6%). Most respondents felt WBV in the extreme uncomfortable category (56.4%) and 72.28% of respondents experienced back pain disability in the severe to very severe category. Analysis of the relationship between WBV and LBP disability was obtained p = 0.001. Conclusion. There is a significant relationship between WBV and LBP disability. The greater exposed to WBV, people have the higher risk of developing LBP disability.

Intra-abdominal Content Movement in Prone Versus Lateral Decubitus Position Lateral Lumbar Interbody Fusion (LLIF).

A prospective, anatomical imaging study of healthy volunteer subjects in accurate surgical positions. To establish if there is a change in the position of the abdominal contents in the lateral decubitus (LD) versus prone position. Lateral transpsoas lumbar interbody fusion (LLIF) in the LD position has been validated anatomically and for procedural safety, specifically in relation to visceral risks. Recently, LLIF with the patient in the prone position has been suggested as an alternative to LLIF in the LD position. Subjects underwent magnetic resonance imaging of the lumbosacral region in the right LD position with the hips flexed and the prone position with the legs extended. Anatomical measurements were performed on axial magnetic resonance images at the L4-5 disc space. Thirty-four subjects were included. The distance from the skin to the lateral disc surface was 134.9mm in prone compared with 118.7mm in LD ( P <0.0001). The distance between the posterior aspect of the disc and the colon was 20.3mm in the prone compared with 41.1mm in LD ( P <0.0001). The colon migrated more posteriorly in relation to the anterior margin of the psoas in the prone compared with LD (21.7 vs . 5.5mm, respectively; P <0.0001). 100% of subjects had posterior migration of the colon in the prone compared with the LD position, as measured by the distance from the quadratum lumborum to the colon (44.4 vs . 20.5mm, respectively; P <0.001). There were profound changes in the position of visceral structures between the prone and LD patient positions in relation to the LLIF approach corridor. Compared with LD LLIF, the prone position results in a longer surgical corridor with a substantially smaller working window free of the colon, as evidenced by the significant and uniform posterior migration of the colon. Surgeons should be aware of the potential for increased visceral risks when performing LLIF in the prone position. Level II-prospective anatomical cohort study.

Comparative evaluation of efficacy of Trayodashang Guggul versus Rasona Pinda as an adjuvant with Katibasti in the management of Grudhrasi (Sciatica): A randomized controlled trial

Background In ayurveda, sciatica can be correlated to ‘Grudhrasi’ under Vata Nanatmaja-Vyadhi (neurological disorders caused by Vata, one of the bodily humour). In this mainly bodily humours vata and kapha are vitiating producing symptoms like piercing pain, stiffness, twitching, numbness and pain radiating from lumbosacral region to lower limb up to the foot. Therapeutic plan includes stabilizing and bringing back the vitiated vata and kapha humours to equilibrium. The prevalence of sciatica varies considerably ranging from 3.8% in the working population to 7.9% in the nonworking population. Aim Comparative evaluation of efficacy of Rasonapinda and Trayodashang guggul as an adjuvant to katibasti (oil pooling therapy) in the management of Grudhrasi (Sciatica). Objectives To assess the efficacy of Rasonapinda as an adjuvant to katibasti in subjective and objective parameters of Grudhrasi (Sciatica). To assess the efficacy of Trayodashang guggul as an adjuvant to katibasti in subjective and objective parameters of Grudhrasi (Sciatica). To compare the efficacy of Rasonapinda and Trayodashang guggul as an adjuvant to katibasti in subjective and objective parameters. Standardisation of Rasonapinda (modified formvati). Methods In this study, a total of 60 patients will be enrolled and divided equally into two groups. In group A, Trayodashang Guggul 500 mg twice a day after meal with warm water for 30 days adjuvant with katibasti for the initial 7 days will be given. In group B, Rasonapinda 500 mg twice a day after meal with warm water adjuvant with katibasti for the initial 7 days will be given for 30 days. Result The result will be assessed on baseline of subjective and objective parameters and data will be compared after treatment. Conclusions It will be based on observations and results obtained. Trial registration CTRI No. - CTRI/2022/12/048534 Dated – 27/12/2022.

Ergogenic effects of spinal cord stimulation on exercise performance following spinal cord injury.

Cervical or upper-thoracic spinal cord injury (SCI, ≥T6) often leads to low resting blood pressure (BP) and impaired cardiovascular responses to acute exercise due to disrupted supraspinal sympathetic drive. Epidural spinal cord stimulation (invasive, ESCS) and transcutaneous spinal cord stimulation (non-invasive, TSCS) have previously been used to target dormant sympathetic circuits and modulate cardiovascular responses. This case series compared the effects of cardiovascular-optimised ESCS and TSCS versus sham ESCS and TSCS on modulating cardiovascular responses and improving submaximal upper-body exercise performance in individuals with SCI. Seven males with a chronic, motor-complete SCI between C6 and T4 underwent a mapping session to identify cardiovascular responses to spinal cord stimulation. Subsequently, four participants (two ESCS and two TSCS) completed submaximal exercise testing. Stimulation parameters (waveform, frequency, intensity, epidural electrode array configuration, and transcutaneous electrode locations in the lumbosacral region) were optimised to elevate cardiovascular responses (CV-SCS). A sham condition (SHAM-SCS) served as a comparison. Participants performed arm-crank exercise to exhaustion at a fixed workload corresponding to above ventilatory threshold, on separate days, with CV-SCS or SHAM-SCS. At rest, CV-SCS increased BP and predicted left ventricular cardiac contractility and total peripheral resistance. During exercise, CV-SCS increased time to exhaustion and peak oxygen pulse (a surrogate for stroke volume), relative to SHAM-SCS. Ratings of perceived exertion also tended to be lower with CV-SCS than SHAM-SCS. Comparable improvements in time to exhaustion with ESCS and TSCS suggest that both approaches could be promising ergogenic aids to support exercise performance or rehabilitation, along with reducing fatigue during activities of daily living in individuals with SCI.

Постоперационный контроль нейрохирургических операций у собак

Surgical operations on the spine can be accompanied by a number of complications associated with surgical access, iatrogenic neurological complications, complications associated with wound infection, and imperfect instrumentation. In this regard, not all operations lead to the expected restoration of motor function even in the initial stages of neurological disorders, and identifying the justification for routine postoperative monitoring using visual diagnostic methods (CT/MRI) in patients after spinal surgery is the main goal of this study. A sample of patients was carried out who underwent operations: ventral spondylectomy for disc extrusion, stabilization of the cervical spine for wobbler syndrome, decompression in the thoracolumbar and lumbosacral regions with and without stabilization. Thus, of the patients who underwent a control study, reoperation was required for ventral spondylectomy in 10,3 % of cases, stabilization of the cervical spine – 13,04 %, stabilization of C1-C2 – 4,1 %, hemilyaminectomy/ minihemilaminectomy in the thoracolumbar spine department – 3,5 %, hemilyaminectomy/ minihemilaminectomy in the thoracolumbar region with stabilization – 13,6 %, dorsal laminectomy L7-S1 without stabilization – 0 %, dorsal laminectomy L7-S1 with stabilization – 15,2 %.

A Complete Non-fusion of Sacral Spines- a Rare Anomaly: A Case Report

Background: Human sacrum is a large triangular bone formed by fusion of five separate sacral vertebrae and their intervertebral disc. The dorsal surface of sacrum presents triangular sacral canal formed by fusion of sacral vertebral foramina. The opening present at the caudal end of the sacral canal is known as sacral hiatus. Sacral hiatus is formed due to failure of fusion of lamina and spinous process of fifth or fourth sacral vertebrae. Spina bifida occulta is a condition resulting due to incomplete fusion of neural arch of vertebrae, mainly in lumbosacral region. When the condition of spina bifida occulta occurs in the sacrum, the level of non-closure becomes variable. Materials and Methods: A dry human sacrum with full agenesis of the dorsal wall of the sacral canal was identified during regular osteology demonstration lessons for undergraduate BAMS students at Department of Sharir Rachana (Anatomy), Ayurveda Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal. Non-metric differences in spines were thoroughly examined. Results and Discussion: Spina bifida is the generic term for range of discrete defects of neurulation and subsequent vertebral formation. The various forms of neural tube and vertebral defects have been reported such as craniorachisis, anencephaly and myocele. In this case a spine with complete sacral spina bifida occulta was discovered. The posterior laminae of all sacral vertebrae were completely unfused in this specimen. It's more likely that the sacral region was a groove than a canal. There were no additional abnormalities discovered. Many studies on incidence of spina bifida occulta have been published with mixed results. The frequency reported by researchers and population varies substantially. Conclusion: The complete agenesis of the dorsal wall of the sacral canal in these variants is critical for diagnosing lower back pain, sciatica, and caudal regression syndrome, as well as avoiding problems from caudal epidural block and other spinal procedures, such as screw placement for spinal fusion.

Neuromodulation in Spinal Cord Injury Using Transcutaneous Spinal Stimulation-Mapping for a Blood Pressure Response: A Case Series.

Spinal cord transcutaneous stimulation (scTS) offers a promising approach to enhance cardiovascular regulation in individuals with a high-level spinal cord injury (SCI), addressing the challenges of unstable blood pressure (BP) and the accompanying hypo- and hypertensive events. While scTS offers flexibility in stimulation locations, it also leads to significant variability and lack of validation in stimulation sites utilized by studies. Our study presents findings from a case series involving eight individuals with chronic cervical SCI, examining the hemodynamic effects of scTS applied in different vertebral locations, spanning from high cervical to sacral regions. Stimulation of the lumbosacral vertebrae region (L1/2, S1/2, and also including T11/12) significantly elevated BP, unlike cervical or upper thoracic stimulation. The observed trend, which remained consistent across different participants, highlights the promising role of lumbosacral stimulation in neuromodulating BP.

Ekstrarenalni Vilmsov tumor koji je imponovao kao funikulocela

Introduction/Objective: Extrarenal Wilms' tumor (ERWT) comprises 0.5% to 1% of all nephroblastoma cases. The most common locations of ERWT are the retroperitoneum, inguinal, lumbosacral and pelvic region, female genital organs, mediastinum and chest wall, spermatic cord and paratesticular region. ERWT most likely originates from the ectopic nephrogenic rest that undergoes a malignant transformation. The exclusion of primary renal tumor is necessary to establish the diagnosis of ERWT. Patient Review: A 15-month-old male was operated on because of a left-sided inguinal mass that clinically resembled a funicular hydrocele. The surgical exploration of the inguinal canal revealed a solid tumor located in the area of the external inguinal ring, measuring around 2cm in diameter, with no ingvinal hernia present. Complete surgical resection of the mass was performed. The histological structure of the tumor corresponded to non-anaplastic nephroblastoma (Wilms tumor), mixed type. After abdominal CT scan primary renal tumor was excluded and the diagnosis of ERWT was made. Because of microscopic tumor rests on the resection margin, the patient was treated according to the high-risk SIOP Wilms tumor protocol. The patient made a full recovery. During the 10-year follow-up, the boy has remained disease-free. Conclusion: ERWT is mostly diagnosed after the surgical removal of the specimen. The clinical resemblance of the ERWT located in the inguinal region to common benign inguinal conditions in children may lead to the omission of detailed preoperative work-up. Most children with ERWT in the inguinal region have an excellent prognosis, although most of them require adjuvant chemotherapy and/or radiotherapy after surgery.

Evaluation of the electromyography activity of hindlimb muscles during core exercises in horses

IntroductionTherapeutic exercise is key in rehabilitation programs, so they must be specific, individualised, and reasoned. Biomechanical studies using surface electromyography have allowed us to make an evidence-based selection of the most appropriate exercises for each patient. The literature describes different electromyography activities in many muscles during different exercises, including walking, trotting, galloping, poles, and slopes, among others, but research on exercises performed in standing horses is lacking. Inclusion in rehabilitation programs of these exercises is based on an effect extrapolated from an anatomical and biomechanical concept of the muscles and not on surface electromyography evidence. This study evaluated the effect of six therapeutic exercises commonly used in horse rehabilitation programs on four muscles (m. gluteus medius, m. tensor fasciae latae, m. biceps femoris, and m. gracilis), to objectively measure the activity they generate by surface electromyography. Material and methodsSix horses performed six selected core exercises: axial tail traction, lateral tail traction, lateral tail traction to the contralateral side, lumbosacral flexion, lumbosacral extension, and caudal weight displacement. The activity was recorded by surface electromyography in four hindlimb muscles, including the m. gluteus medius, m. tensor fasciae latae, m. biceps femoris, and m. gracilis, and the signal registered was rectified and smoothed using the root mean square (RMS) algorithm. Finally, the data obtained was subjected to a statistical analysis using an ANOVA for the differential voltage factor followed by a Duncan multiple range analysis to determine which muscles activated each exercise. ResultsMaximum activity was observed for m. gluteus medius with lateral tail traction (41.55 μV) and lumbosacral flexion (46.72 μV); m. tensor fasciae with lateral tail traction (40.63 μV); m. biceps femoris with lumbosacral flexion (22.22 μV); and m. gracilis with axial tail traction (39.48 μV), lateral tail traction to the contralateral side (56.43 μV), lumbosacral flexion (68.72 μV), and caudal weight displacement (41.12 μV). ConclusionsM. biceps femoris was moderately activated during lumbar flexion, indicating it is not as relevant in pelvic stability as previously assumed. M. gluteus medius, m. biceps femoris, and m. gracilis activity during lumbar flexion suggests their potential involvement in the stability of the lumbosacral region. m. gracilis exhibited more activity than expected, indicating a significant role in pelvis and hip stability.

IDENTIFIKASI FAKTOR RISIKO KEJADIAN LOW BACK PAIN PADA PEKERJA INDUSTRI KATERING

Background: Low back pain is pain that is felt in the affected anatomical area with various variations in the duration of pain. This pain is felt in the lumbar or lumbo-sacral region. Occupational diseases caused by non-ergonomic conditions include musculoskeletal disorders. Food industry workers are at risk of low back pain due to their activities such as bending, lifting and carrying heavy loads for a long time and repetitively. The purpose of this systematic review is to determine the relationship of position and length of work of ketring business workers to the incidence of LBP. Methods: searches are conducted through Google Scholars, PubMed, Cochrane Library, ResearchGate and Science Direct. Obtained 30 journals that contain the topic of low back pain in catering industry workers. Results: from 30 journals, 12 cross-sectional studies, 7 systematic Reviews, 4 literature reviews, 5 cohort studies, 1 meta-analysis, and 1 case-control study were obtained. Discussion: LBP occurs due to the biomechanics of the lumbar vertebrae due to changes in body weight points with compensation for changes in body position and will cause pain. Muscle strain and spinal ligament sprain are among the main causes of LBP. lifting positions that are less ergonomic and repetitive in the long term are causing complaints of low back pain in ketring workers. Conclusion: the risk factors for low back Pain (LBP) in workers in the mining industry are caused by several factors such as position and posture when working which tend to be static and repetitive, old age workers, workers with excess weight. Keywords: Risk factor, LBP, worker, kitchen, catering

Post-mortem ultrasonographic and computed tomographic features of the anatomical variations and acquired pathological bony changes of the lumbosacroiliac region in a mixed population of horses.

Transrectal ultrasonography is the best technique for evaluating the ventral aspect of the lumbosacral and sacroiliac regions yet this diagnostic technique does not always lead to a final diagnosis of back pain in horses. To describe anatomical variations and acquired pathological bony changes (APBCs) in the lumbosacral and sacroiliac regions detected by ultrasonography (US) and computed tomography (CT) examinations on specimens. We hypothesised that age, body mass, previous use and anatomical variations may be correlated with the presence and/or severity of APBCs. Descriptive cadaver study. Lumbosacroiliac specimens were obtained from 51 horses that died or were euthanised for reasons other than the study and underwent US and CT examinations post-mortem. Forty-two specimens were analysed. The most prevalent lumbosacral disc morphology was type 2 (21/42), and protrusions were found in 15/42 specimens. Abnormal echogenicity of the L5-L6 and lumbosacral discs was detected in 11/42 and 30/42 specimens, respectively. Abnormalities in the size of the L5-L6 disc were found in 10/42 specimens and correlated with promontorium localisation (Cramér's V coefficient [V] = 0.42) and lumbosacral disc morphology (type 1: V = 0.41; type 5: V = 0.69). The most prevalent orientation of the L6 spinous process (SP) was convergent (24/42). The promontoria were mostly located between L6 and S1 (36/42). Lumbosacral spondylosis was detected in 24/42 specimens and spondylolisthesis in one. Age was associated with the severity of APBCs in the sacroiliac joints, lumbosacral intertransverse joints, articular process joints, spondylosis and L6 or S1 bone plate irregularities. Lumbosacral spondylosis or L6 extremitas caudalis irregularity was associated with lumbosacral angulation, variability in the size of the L5-L6 disc and localisation of the promontorium, L6 SP orientation and L6 extremitas caudalis irregularity with abnormal echogenicity of the LS disc. Lack of information on clinical signs. High variability and prevalence of the anatomical variations and APBCs in the lumbosacroiliac region were observed, and correlations between some anatomical variations and APBCs and between APBCs and age were reported.

Radiographic characteristics-based classification system for percutaneous endoscopic lumbar discectomy surgical approach selection in patients with L5-S1 disc herniation: a hierarchical clustering analysis.

No classification system exists for aiding the selection of surgical approaches in L5-S1 disc herniation when undergoing percutaneous endoscopic lumbar discectomy (PELD). We aimed to identify radiographic subtypes to aid the selection of percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) in patients with L5-S1 disc herniation via unsupervised hierarchical clustering analysis. In this retrospective case-control study, we gathered 296 anteroposterior and lateral lumbar spine radiographs (dataset 1) from Tianjin Hospital between January 2016 and October 2021 for clustering analyses. Additionally, we analyzed 111 patients who underwent PEID or PETD for L5-S1 disc herniation at Tianjin Hospital from January 2016 to August 2022. We included patients with radicular leg pain or back pain associated with intra-canal disc herniation who failed in conservative treatments over 6 weeks. First, pair-wise Spearman correlation coefficients were calculated among plain radiographic metrics in dataset 1 to reveal the association among these radiographic metrics. Second, hierarchical clustering analysis was conducted to unsupervised cluster the plain films into several subtypes. Last, for each radiographic subtype, the intraoperative blood loss (IBL), operation time (OT), total operating room time (TORT) along with visual analogue scale (VAS) and Oswestry Disability Index (ODI) were compared between patients underwent PETD or PEID with age as covariates. This study yielded 3 main findings: (I) iliac height (IH) was negatively correlated with intervertebral foramen width (IFW), intervertebral foramen height (IFH), and intertransverse height (ITH) (R=-0.50, -0.42, and -0.46, all P<0.001), ITH was positively correlated with IFW and IFH (R=0.40 and 0.53, all P<0.001); (II) 2 lumbosacral radiographic subtypes were identified via hierarchical clustering analysis; (III) relative to subtype 1, the patients identified as subtype 2 exhibited lesser IBL, shorter OT, and shorter TORT following PETD (t=2.92, P=0.006; t=2.65, P=0.012; t=3.17, P=0.003). The morphology pattern of the lumbosacral region affect the ease of different PELD procedures when performing percutaneous discectomy at the segment of L5-S1. Without considering the type of disc herniation, this classification system might aid spine surgeons in the selection of an appropriate surgical approach.

Remote assessment of pelvic kinematics during single leg squat using smartphone sensors: Between-day reliability and identification of acute changes in motor performance.

The biomechanical assessment of pelvic kinematics during a single leg squat (SLS) commonly relies on expensive equipment, which precludes its wider implementation in ecological settings. Smartphone sensors could represent an effective solution to objectively quantify pelvic kinematics remotely, but their measure properties need to be evaluated before advocating their use in practice. This study aimed to assess whether measures of pelvic kinematics collected remotely using smartphones during SLS are repeatable between days, and if changes in pelvic kinematics can be identified during an endurance task. Thirty-three healthy young adults were tested remotely on two different days using their own smartphones placed on the lumbosacral region. Pelvic orientation and acceleration were collected during three sets of seven SLS and an endurance task of twenty consecutive SLS. The intersession reliability was assessed using Intraclass Correlation Coefficient (ICC2,k), Standard Error of Measurement, and Minimal Detectable Change. T-tests were used to identify pelvic kinematics changes during the endurance task and to assess between-day bias. Measures of pelvic orientation and frequency features of the acceleration signals showed good to excellent reliability (multiple ICC2,k ≥ 0.79), and a shift of the power spectrum to lower frequencies on the second day (multiple p<0.05). The endurance task resulted in larger contralateral pelvic drop and rotation (multiple p<0.05) and increased spectral entropy (multiple p<0.05). Our findings demonstrate that reliable measures of pelvic kinematics can be obtained remotely using participants' smartphones during SLS. Smartphone sensors can also identify changes in motor control, such as contralateral pelvic drop during an endurance task.

Clinical and instrumental features of vertebrogenic lumbosacral pathology in machine milking operators

In the structure of occupational pathology, female workers of modern agricultural production, along with diseases of the musculoskeletal system and soft tissues of the upper extremities, vertebrogenic lesions of the lumbosacral level have become more often diagnosed. The aim of the study was to study the features of vertebrogenic pathology of the lumbosacral region with the analysis of radiological and electroneuromyographic data in machine milking operators of the Republic of Bashkortostan. The following results were obtained. On radiographs of the lumbosacral spine, degenerative-dystrophic changes in the form of a decrease in the height of discs, spondylosis, spondyloarthrosis were noted in machine milking operators. Electroneuromyographic criteria revealed a decrease in amplitude and velocity parameters of conduction along the peripheral nerves of the lower extremities. The revealed changes in vertebrogenic lumbosacral pathology in the examined patients make it possible to ensure timely diagnosis and prevention of production-related pathology with the formation of rational schemes of therapeutic and recreational measures.

Retrospective Examination of Infants With Congenital Neural Tube Defect.

In the present study, neonates presenting with neural tube defects (NTDs) and undergoing observation within the confines of the neonatal intensive care unit (NICU) were subjected to a comprehensive assessment encompassing concurrent morbidities, clinical manifestations, laboratory parameters, and instituted interventions. A retrospective examination was conducted on the medical records of 135 neonates diagnosed with congenital NTD within the temporal span from 2008 to 2018. The study cohort was drawn from the NICU of the Health Sciences University Erzurum Regional and Research Hospital Health Practice and Research Center. The current investigation encompasses a retrospective analysis of 135 patients diagnosed with NTDwho received treatment at the NICUbetween the years 2008 and 2018. Among these, 74 individuals (54.2%) were male, while 61 (45.8%) were female. Maternal ages ranged from 17 to 46 years, with variations in the number of pregnancies, ranging from 1 to 10. Notably, 71 cases (52.6%) were delivered through normal spontaneous delivery, whereas 64 cases (47.4%) underwent cesarean section. The familial context revealed that five patients (3.6%) had siblings with a history of NTD, while no instances were noted where mothers had received antenatal folic acid support. Birth weights of the neonates ranged from 1425 to 4500 grams. Consanguinity was identified in the parental relationships of 17 cases (12.6%). The average diameter of the neural tube sac was determined to be 4.83± 1.94 cm (1-12 cm). Predominantly, the lumbosacral region emerged as the most common site of NTD, with meningomyelocele being the prevailing NTD type. Hydrocephalus coexisted in 67 cases, and notably, 44 instances exhibited the development of hydrocephalus post-sac operation. Eight patients were deemed inoperable, and the initial surgery transpired at an average age of 4.3 ± 2.6 (0-17) days. Flap closure constituted 32 of the surgical interventions, while primary closure was implemented in 95 cases. Neurogenic bladder antedated the operation in 14 patients, and 12 individuals developed neurogenic bladder postoperatively. Ventriculoperitoneal shunt placement was warranted in 47 patients. The average duration of hospitalization was 22.5 ± 14.4 days. Regrettably, three patients died due to complications and infections during their hospital stay. NTDrepresents a significant cohort of pathologies necessitating a comprehensive and interdisciplinary management strategy. These anomalies are characterized by elevated morbidity and mortality rates, not only exerting substantial financial strains on societal, familial, and state healthcare resourcesbut also inflicting profound emotional distress upon affected families. Crucially, periconceptional strategies emphasizing balanced nutritioncoupled with targeted multivitamin and mineral supplementation, particularly the inclusion of folic acid, assume paramount importance in the prophylaxis of this debilitating condition.

Clinical findings of Tarlov cyst according to its location and level in lumbosacral spine on magnetic resonance imaging

Background: Tarlov cysts are fluid filled cysts that are most found in the lumbosacral spine. Patients often present with a series of distinguished neurological deficits that correlate with the mass effects of cyst provided on the level and location of the lumbosacral spine. Objective: To determine the clinical findings of Tarlov Cyst associated with its level and location magnetic resonance imaging Methods: A total of 60 patients with different sets of neurological deficits were included in this descriptive cross-sectional study conducted in Ghurki Trust and Teaching hospital. Data was collected by using Questionnaire/Performa. An MRI procedure was used to assess the Tarlov cysts. A Convenient sampling technique was used in this study. Data was evaluated and analysed with SPSS v-25 and Microsoft excel. Results: Out of 60 patients, there were 40 females (66.67 %) and around 20 males (33.3%). The most common neurological deficits that was found in patients were numbness seen in 50 patients, loss of reflexes seen in 40 patients, mass effects in the affected region were seen in 20 patients and changes in the bowel function was seen in 10 patients. The most common location of Tarlov cysts found in patients was sacral region 28(46.7%), lumbosacral region 24(40%) and lumbar region 8(13.3%). Conclusion: The study concluded that the frequency of female was more than male. And the most common site of Tarlov cyst was found to be at LV4-LV5 and LV5-level S1 exhibiting different clinical manifestation.

Particularities of ballistic spinal injuries and management in an African context (Chad): Study of 27 cases

The frequency of ballistic spinal injuries is rising in developing nations around the globe. These injuries lead to a functional prognosis linked to disabling sequelae and vitals in patients, which often results in serious complications and death.This study describes the epidemiological, diagnostic, therapeutic, evolutionary characteristics of Ballistic Medullar-Vertebral trauma (BMVT). It presents the particularities of management in the sub-Saharan African country of Chad.This is a prospective descriptive study of 27 ballistic spinal injury patients conducted over an 18-month period.Ballistic Medullar-Vertebral injuries (BMVI) represented 12.9 % of spinal trauma. The average age of the patients was 31.8, and 40.7 % were between 31 and 40 years of age. Military personnel represented 78 % of the patients. 44.4 % of cases came from the Lake Chad region. 59.3 % of injuries were caused by Kalashnikov’s (AK 47) firearms. 74.1 % of cases were admitted to the emergency department within 12 to 24 h. The diameter of the wounds that corresponded to the entry orifice of the bullet was between 1 and 2 cm in 59.25 % of the cases. A Dural breach was found in 14.8 %. 48.1 % had ASIA C score and none of them met the criteria for spinal cord injury collection and immobilization. The lumbosacral location was reported in 55.6 %, and the type I Roy Camille fracture was found in 70.37 %. Surgical management was performed in 88.9 % cases. Multidisciplinary management of the associated lesions was performed in 25.9 %. 7.4 % of patients with cervical trauma died due to septic shock.Delayed emergency department admissions and limited access to medicalized transportation are main factors to BMVI in Chad. Lesion is predominantly located in the lumbosacral region. Lesions and spinal cord involvement were factors of poor vital and functional prognosis. Surgery plays an important role in management. Socio-professional reintegration remains problematic.

Lower-Extremity Fillet Flap for Reconstruction of Complex Stage IV Pressure Sores and Plantar Flap for Lumbosacral Padding.

The lower-extremity fillet flap is a suitable option for the repair of complex (multiple or complicated with osteomyelitis) stage IV pressure sores. If prepared from a nonfunctional extremity, it can close complex wounds and avoid the unnecessary burden of a nonfunctional organ that restricts patient movement, thereby improving quality of life. We used a lower extremity fillet flap for reconstruction in 5 patients with complex stage IV pressure sores. The flaps were prepared from the nonfunctional lower extremity with multiple lesions by using iliofemoral disarticulation. The mean age of the patients was 60 years old, and the mean follow-up period was 18 months. A plantar flap was used in 1 patient for prophylactic padding of the lumbosacral region. In another patient, the plantar flap was used as a sensate flap. No major complications, such as total or partial flap loss, occurred in these patients. In 1 patient, a hematoma developed under the flap that led to dehiscence; however, it healed uneventfully without flap loss. Patients developed minimal pelvic stability and balance loss because of iliofemoral disarticulation, but it did not affect their sitting ability and mobility. After the operation, all patients became increasingly active and mobile because of the absence of excess weight on their nonfunctional legs, allowing them to easily perform daily activities such as turning in bed, using a wheelchair, eating, and dressing. Pressure sores did not develop in any of the patients during the postoperative follow-up period. The patient who underwent lumbosacral padding with a sensate plantar flap began to perceive touch over the flap in the fifth postoperative month. These results suggest that a lower-extremity fillet flap can be a good repair option in complex stage IV pressure sores because it prevents recurrence and enables patients to perform daily activities more easily. Furthermore, plantar flaps can provide prophylactic padding in the lumbosacral region.

Role and anti-inflammatory mechanisms of acupuncture and moxibustion therapy on pain relief through NOX-ROS-NLRP3 pathway in CCI rats models.

To observe the effects of acupuncture and moxibustion therapy on pain relief in sciatica rats and to explore the mechanism of its anti-inflammatory effect. SPF grade 4-6-week-old Kunming rats were randomly divided into 5 groups including a blank group, sham-operated group, model group, acupuncture, and moxibustion (AnM) group, and positive group. A total of 10 rats were included in each group. The model group, the AnM group, and the positive group were prepared by ligating the left sciatic nerve. AnM group was used for acupuncture and moxibustion therapy intervention, and the positive group was rendered to quick-acting sciatica pills once a day for 7 days (3 courses of treatment). The blank group, sham-operated group, and model group were not treated. The changes in thermal and mechanical pain thresholds were observed before and after the operation, and the morphological changes of the dorsal horn of the spinal cord in the lumbosacral region of the rats in each group were observed by HE staining after the courses of treatment finished. The contents of IL-1β, IL-6, IL-18, and TNF-α were measured by ELISA and the expressions of NOX1, NOX2, NOX4, and NLRP3 genes were detected by RT-qPCR while the protein expressions of NOX1, NOX2, NOX4 and NLRP3 were analyzed by Western blotting. The AnM and positive group showed a significant increase in thermal and mechanical pain thresholds after treatment, while there was no significant change in the model group. As compared to the control group, the contents of IL- 1β, IL-6, IL-18, and TNF-α, as well as the relative expressions of NOX1, NOX2, NOX4, and NLRP3 genes were significantly increased in the model group (P < 0.05 or P < 0.01). As compared to the model group, the contents of IL-1β, IL-6, IL-18, and TNF-α, as well as the relative expressions of NOX1, NOX2, NOX4, and NLRP3 genes significantly decreased in the AnM and positive groups (P < 0.05 or P < 0.01). The pathological changes of inflammatory infiltration of tissue cells in the dorsal horn of the lumbosacral spinal cord were slowed in the AnM group. Acupuncture and moxibustion therapy have a positive effect on pain relief and anti-inflammatory effects in CCI sciatica rats, which may point to the regulation of NOX1, NOX2, NOX4, and NLRP3 expressions, and inhibition of ROS.

Angiographic challenges of spinal dural and epidural arteriovenous fistulas: report on 45 cases.

The localization of the fistula level in spinal dural arteriovenous fistulas (dAVFs) and epidural arteriovenous fistulas (edAVFs) remains a diagnostic challenge. Consecutive patients with spinal dAVFs and edAVFs in the thoracic, lumbar, and sacral regions were included. The primary endpoint was to describe the characteristics of patients who required angiography with multiple catheterizations of segmental arteries (10 or more). Forty-five patients (median age 69years; male 89%; dAVFs, n = 31; edAVFs, n = 14) were included. Spinal dAVFs commonly developed in the thoracic region and edAVFs in the lumbosacral region. Fistulas were predicted at the correct level or plus/minus 2 level in less invasive examinations using multi-detector CT angiography (n = 28/36, 78%) and/or contrast-enhanced MR angiography (n = 9/14, 64%). We encountered diagnostic challenges in the localization of fistulas in 6 patients. They underwent angiography a median of 2 times. In each patient, spinal levels were examined at a median of 25 levels with a median radiation exposure of 3971mGy and 257ml of contrast. Fistulas were finally localized at the high thoracic region (T4-6) in 3 patients, the sacral region (S1-2) in 2, and the lumbar region (L3) in 1. Four patients were diagnosed with edAVFs and 2 with dAVFs. The correlation coefficient between the fistula level and the rostral end of the intramedullary T2 high-signal intensity on MRI was interpreted as none. In patients in whom less invasive examinations failed for fistula localization, high thoracic or sacral AVFs need to be considered.