Resonance Imaging Of Lumbosacral Spine Research Articles

Tadpole Sign in Filum Terminale Paragangliomas

Two normotensive male patients came with complaints of low back pain. Contrast-enhanced magnetic resonance imaging of the lumbosacral spine revealed an enhancing intradural extramedullary lesion (at the L4-L5 vertebral level in the first patient and at the L2-L3 vertebral level in the second patient). The tumor resembled the head and caudal blood vessels the tail of a tadpole, thereby giving the "tadpole sign." This sign is an important radiologic and histopathologic correlate, which is helpful in preoperative diagnosis of spinal paraganglioma.

Adolescent Lumbar Intervertebral Disc Herniation: Conservative versus Surgical Treatment

BACKGROUND: Lumbar disc herniation (LDH) in adolescents is relatively a rare condition among those cases presented with low back pain. Trauma and genetics are the most common predisposing factors. Furthermore, the clinical presentations differ from those of the adults. Back pain is not all marked in adolescent patients. AIM: This study was subjected to discuss the etiology, diagnosis and treatment modalities, and the variable outcomes for both medical and surgical treatment of LDH in adolescents. PATIENTS AND METHODS: This prospective study was conducted on 20 patients (12 males, eight females) age range 10–19 years presenting with LDH, managed and treated conservatively and/or surgically in Neurosurgery Department at Kasr Al Ainy School of medicine, Cairo University in the period from October 2015 to September 2016 with 12-month follow-up period. RESULTS: In our study, 12 patients (60%) gave a positive family history, also nine cases (45%) had a history of back trauma before affection with LDH. All the cases (100%) were presented with sciatic pain while only half of them had low back pain, also two cases with motor deficit. After performing magnetic resonance imaging of lumbosacral spine, L5-S1 disc level was the most common level affected. All the patients were subjected to medical treatment which was effective in 40% of the cases and surgical treatment was the only curative method in 12 cases (60%). In this study, the outcome was excellent in 90% of cases where significant to complete relief of pain and significant improvement in the neurological deficits was achieved. CONCLUSION: Conservative treatment is less effective for adolescent LDH patients as compared with adults, even though it remains the fi rst-line treatment for adolescent LDH.

Aplicación De Secuencia T2 Panorámica Para Resonancia Magnética De Columna Lumbosacra

Aplicación De Secuencia T2 Panorámica Para Resonancia Magnética De Columna Lumbosacra

Outcome of micro-lumbar discectomy and preventive measures to control discitis

Objective: The purpose of the present study is to describe the rate of post-operative discitis following micro-lumbar discectomy.
 Methods and Materials: This is a retrospective study of 203 patients who underwent micro-lumbar discectomy between March 2015 and April 2018 in our institute. Prior to surgery, patients were optimized by maintaining personal hygiene, controlling blood sugar in diabetics and withholding steroids. Standardized intra-operative measures were taken to prevent discitis. Post-operatively on day 7, patients were evaluated for symptoms like back pain, fever and wound infection. If there was any sign of infection then the patient was evaluated with a plain x-ray of lumbosacral spine, inflammatory blood markers like complete blood count, erythrocyte sedimentation rate, C-reactive protein and Magnetic Resonance Imaging of lumbosacral spine to rule out discitis.
 Results: There were 127 males and 76 females, the age ranging from 8 years to 80 years. MRI imaging showed 94.6% single and 5.4% multilevel disc prolapses with 4.2% high lumbar and 95.8% low lumbar disc prolapse. Indications for surgery were failed conservative treatment (44), intractable pain (102), neurological deficit (49), and cauda equina syndrome (8). None of the 203 patients developed post-operative discitis, however, some of them had nerve root injury (4), dural tear (5), wound infection (5) and pseudo-meningocele (2). Almost all patients were mobilized within 48 hours (98%) after surgery. 95% were discharged on the 7th day of surgery and 5% within two weeks. Radicular pain was relieved in 92% patients within one week, 6% within three weeks and 2% had no change. Low back pain was relieved in 80% of patients in three weeks, 15% in three months and 5% had persistent back pain. The recurrence rate was 2.5% in our series. 80% had joined their previous job after four weeks, 15% after three months and 5% had changed their job.
 Conclusions: Post-operative discitis can be prevented if appropriate precautions are taken like using separate dedicated neurosurgical operation theatre, prophylactic antibiotics, minimally invasive procedure and not curating the end-plates.

Relationship between age, gender and low back pain in patients referred for magnetic resonance imaging of lumbosacral spine at ahmadu bello university teaching hospital, Zaria

Context: Low back pain (LBP) is a symptom of many lumbosacral spine abnormalities which are prevalent in all occupational groups in our environment. Its frequency and severity are significantly related to age and gender. Aims: To determine the relationship between age, gender and LBP in patients referred for magnetic resonance imaging (MRI) of lumbosacral spine. Settings and Design: A cross sectional study at Ahmadu Bello University Teaching Hospital, Zaria. Materials and Methods: The study was conducted within 4 years at the MRI suite of the Department of Radiology, on 200 patients who had LBP who had MRI scan. Statistical analysis used: Data from the questionnaires were sorted and entered into Microsoft Excel. Analysis was performed using the Statistical Package for Social Sciences Version 22.0. Results: There is male preponderance, with a male to female ratio of 1.6:1. The ages ranged from 11 to 80 years, with a mean of 47.8 + 1.4, and the peak incidence (55 [27.5%]) is in the fourth and fifth decades of life. A statistically significant association (χ2 = 33.9; P

Incidental findings on magnetic resonance imaging of lumbosacral spine in patients with back pain and/orradiculopathy

Background and objective: An incidental lesion is an asymptomatic lesion found while examining a patient for an unrelated reason. Lumbar spine imaging may reveal either clinically insignificant spine incidental abnormalities and/or extra-spinal Incidental finding that, at times, may even explain the patient’s symptoms. This study aimed to evaluate the frequency and types of incidental findings in lumbosacral magnetic resonance examination and to find the correlation between the frequency distribution of findings in terms of age and sex. Methods: This cross-sectional study involved 1250 persons who were referred for lumbosacral spine magnetic resonance imaging because of low back pain and/or radiculopathy. The magnetic resonance images were viewed to evaluate the frequency of incidental findings which were divided into extra and intraspinal findings. Results: Incidental findings were noted in 332 (26.6%) patients of the 1250 comprising 94 (28.3%) males and 238(71.7%) females. Some of them had more than one incidental finding. Cortical and para pelvic renal cysts were the most common extra spinal incidental findings, while vertebral hemangioma was the most common intraspinal incidental finding. Conclusion: Incidental findings were common in magnetic resonance imaging examination of the lumbar spine, and most were clinically insignificant; however some of these findings may be more significant than the spinal problems being evaluated and can have a significant impact on patient management. Therefore, they should be included in the reports since they will give additional and valuable information.

Findings of magnetic resonance imaging of lumbosacral spine in chronic lower back pain

*Background :Magnetic resonance imaging (MRI) of the lumbar spine is a safe and painless scan that uses a magnetic field and radio waves to produce detailed pictures of the lumbar spine (the bones, disks, and other structures in the lower back), MRI of the lumbar spine can be useful in evaluating symptoms such as lower back pain, leg pain, numbness, tingling or weakness or problems with bladder and bowel control. It can also help to diagnose tumors, bleeding, swelling, developmental or structural abnormalities and infections or inflammatory conditions in the vertebrae or surrounding tissues.
 Aim of study :To detect the cause of chronic lower back pain in patients referring from different departments in our hospital like Orthopaedics, Rheumatology , Surgery & neurology. *Patients & method : About 50 patients selected from February 2011 to December 2011 all of them are complaining from chronic lower back pain referring from different departments. Average age from 23 to 70 year, 31 were male &19 were female, the patients were classified according to their age, sex, occupation, past history of trauma, medical disease & previous surgery.
 *Results Twenty sex of patients (52%) were diagnosed as a PIVD (prolapsed intervertebral discs) at the level of L4-5 & L5-S1, ten(20%) of them diagnosed as degenerative disease of the discs, five patients (10%) diagnosed as Straitening of Spine ( Muscular Spasm), 2 (4%) of them diagnosed as secondary metastases in L1& 2 vertebral bodies, 3 (6%) of them diagnosed as infected disk with gibbus deformity in lower dorsal spines & 4 (8%) had normal lumbosacral spine .
 *Conclusion: 1.High incidence of abnormal MRI study in patients with chronic low back pain .
 2.Highest percent of patients with chronic back pain had disc herniation follow by other pathology .

A case of acute discitis following spinal anaesthesia: a rarity or a tip of the iceberg?

Acute discitis, an inflammatory process of the intervertebral disc, has been reported as a rare complication of bacterial infection or chemical or mechanical irritation most commonly following spinal surgery. It may extend into the adjacent tissue and lead to grave orthopaedic and neurological consequences. Although it has been reported as an infective complication following spinal anesthesia also, its true incidence in our part of the world is not known. It may be higher than generally thought as the technique is overwhelmingly used. Further, we do not know about its awareness among anesthesia practitioners. Here we report a case of acute discitis in a young lady who presented with severe acute low back pain two weeks after spinal anesthesia for caesarean section; magnetic resonance imaging of lumbosacral spine revealed infective spondilodiscitis and she was treated with antibiotics and analgesics. The true incidence of acute infective discitis following spinal anaesthesia in our part of the world is unknown and it may be higher that thought. It can be prevented by using rigorous aseptic techniques, and anesthesia should be administered by appropriately qualified and trained personnel.

Magnetic resonance imaging of lumbar trunk parameters in chronic low backache patients and healthy population: a comparative study.

The aim of this study was to evaluate the lumbar trunk parameters by MRI and investigate their association with chronic low backache. Fifty patients (26 males and 24 females) with mean age 33.54±8.33years with a history of low back pain (LBP) of minimum 3 consecutive months constituted the study group (Group A). To match with the study group, 15 normal healthy volunteers (9 males and 6 females) with no history of back pain were selected (Group B). Both the groups were subjected to magnetic resonance imaging of lumbosacral spine and lumbar trunk parameters were calculated. Trunk width, depth and skin angle were comparable at L3-L4, L4-L5 and L5-S1 disc levels; significant difference with regard to disc angle of L3-L4 (p=0.005) and L4-L5 (p=0.02) and cross-sectional area (CSA) of disc at L4-L5 level (p=0.01) was observed between two groups. There was a tendency of smaller CSA of paraspinal and abdominal oblique muscles in Group A patients, but the measurements were not statistically different from Group B patients. Rectus abdominis muscles showed a unique pattern of larger CSA at L3-L4 and L4-L5 disc levels and smaller CSA at L5-S1 in LBP patients. Intervertebral disc degenerative changes on MRI were observed in 27 (54%) patients in the Group A; and none of the Group B participants showed degenerative changes. Tendency of smaller trunk musculature CSA may be a cause or a result of chronic LBP. A unique pattern of larger CSA at L3-L4 and L4-L5 disc levels and smaller CSA at L5-S1 of Rectus abdominis muscles is observed in LBP patients compared to healthy persons. Differences in disc angles and CSA of disc at L3-L4 and L4-L5 levels between the two groups signify that these may be the predisposing factors leading to LBP due to abnormal load/stress transmission and precipitating early degenerative changes in the disc.

Epidural clonidine for the anaesthetic management for diagnostic procedure.

Sir, Non-operating room anaesthesia (NORA) procedures have increased tremendously over the last few years due to rapid technological developments and have resulted in improved outcomes and survival. The key to providing an optimal anaesthesia in NORA is based on the type of the procedure and the physiology of the patients. Providing anaesthesia in magnetic resonance imaging (MRI) suite poses several unique problems including limited patient access and visibility, absolute need to exclude ferromagnetic components and prevent malfunction of monitoring equipment.[1] Alternative approaches to general anaesthesia are gaining popularity which is being highlighted in the present case. A 35 year old male was admitted in our institute as a diagnosed case of lumbar disc prolapse with impending cauda equina syndrome [Figure 1]. Figure 1 Magnetic resonance imaging of lumbosacral spine of the patient His blood investigations and other parameters were normal. He was advised MRI for a precise diagnosis so as to plan an appropriate intervention. Due to severe back pain and muscle spasm, the patient was unable to lie down in supine position. Looking at the limited resources at MRI suite in our setup, he was given intravenous sedation and analgesic in the form of injection fentanyl, injection midazolam, injection haloperidol and injection dexmedetomidine infusion, but it proved inadequate and MRI could not be done. Hence, next sitting for MRI was planned under regional anaesthesia. After taking written consent and keeping nil orally for 6 h, the patient was taken to operation theatre (OT) with all necessary precautions. L2 –L3 epidural space was identified in the sitting position. After injecting 10ml of bupivacaine 0.25% admixed with clonidine (150 µg), the patient was made to lied own. Within 3 min he was relieved of pain. He remained stable and comfortable in the OT. After observing for 20 min, haemodynamic parameters remained stable, and he was shifted to MRI suite with running intravenous fluid and cordless pulse oximeter. In MRI suite, patient's vital parameters were monitored continuously while intravenous fluid was being administered by infusion. The patient lay supine on the table comfortably. MRI study was completed in 40 min in a single sitting and was uneventful. His blood pressure fell slightly with marginal bradycardia which did not require pharmacological support. The patient was shifted to the recovery room with specific instructions to monitor his vitals, was kept nil orally for another 2 h, and duration of analgesia and motor power in the lower limbs were observed. He received 2 L of intravenous fluids in perioperative period. His vitals were stable throughout the recovery period; pain started after 5 h of injection which was grade 3–4 on the visual analogue scale and motor power of lower limb returned to its previous state in 3 h. Lumbar disc prolapse leading to radiculopathy is a common clinical problem that results in significant disability.[2] Pain and other neurologic symptoms associated with this condition are likely as a result of mechanical compression and local inflammation of spinal nerve roots.[3] Radicular pain is so severe in nature that it may not be relieved by systemic analgesics which as in the present case. Neuraxial bupivacaine 0.25% leads to muscle relaxation with almost stable haemodynamic and good sensory blockade; to prolong the duration of analgesia we added 0.2 µg/kg of clonidine, as it is clinically used to treat neuropathy pain.[4] In addition to analgesia mediated by its action at α-2 adrenergic receptors located in the central and peripheral nervous system, clonidine may have anti-inflammatory activity that could influence pain by other mechanisms.[5] Clonidine acts as an analgesic and anti-inflammatory agent in the setting of peripheral nerve injury. Clonidine has demonstrated effects on reducing both nociceptive and neuropathic pain in experimental models and in clinical use. Studies done previously concluded that epidural clonidine results in functional improvement in radicular pain.[4] From the present case, it can be concluded that epidural clonidine provides significant pain relief, particularly in patients with neuropathic pain. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

A sacro‐caudal spinal cord choroid plexus papilloma in a shar‐pei dog

A seven-year-old shar-pei dog was referred because of severe lumbosacral pain and faecal incontinence of 20 days' duration. Neurological examination was characterised by plegic tail, absence of perineal reflex, dilated anus, perineum and tail analgesia, and severe lumbosacral pain. The neurological clinical signs were suggestive of a selective lesion involving sacral and caudal spinal cord segments and/or related nerve roots. A magnetic resonance imaging of lumbosacral spine was performed and was suggestive of an intradural lesion. Primary or secondary neoplasia was considered as the most probable differential diagnosis. The dog was euthanased upon the owner's request. Histopathological examination confirmed the presence of an intradural-extramedullary neoplastic tissue enveloping intradural tract of spinal nerve roots. On the basis of histological and immunohistochemical findings, a diagnosis of well-differentiated choroid plexus papilloma was made. To the authors's knowledge, this is the first case of primary or metastatic spinal choroid plexus papilloma in dogs.

Giant Subcutaneous Synovial Sarcoma: An Interesting Case

A 45-year-old lady presented to us with a large subcutaneous swelling on her left side of back of 1 year duration. Local examination revealed a 13×12 cm spherical swelling on the left lower paraspinal region. Magnetic resonance imaging of lumbosacral spine revealed a 13×12 cm mass having solid and cystic components with internal septations in the subcutaneous tissue of left posterior paraspinal area. The mass was hetrogenously hyperintense on T 2 weighted images suggestive of synovial sarcoma. Wide local excision of the lump was carried out followed by closure of the defect with a lateral intercostal artery based rotational flap. The histopathology of the excised tumor revealed synovial sarcoma that stained positive for cytokeratin and epithelial membrane antigen. This case highlights an unusually large subcutaneous synovial sarcoma present in para-spinal area.

Melanotic cyst of L5 spinal root: A case report and review of literature

Till date, 85 cases of melanotic schwannoma and 11 cases of spinal root melanoma have been reported in literature. We are reporting a case of a 45-year-old lady who presented with primary low back pain, and magnetic resonance imaging of lumbo-sacral spine showed at left L5-S1 foraminal lesion extending to the para-spinal compartment. Hemi-laminectomy, facetectomy, and excision of the lesion were done. It was primarily a cystic lesion with attachment to the exiting spinal nerve root. Histopathology of the cyst wall showed a fibro-collagenous stroma with no specific cell lining containing melanin pigment suggestive of a melanotic cyst. The patient was completely relieved of the back pain, and had no recurrence over a follow-up period of one and half years. This case is probably the first reported predominantly cystic, pigmented lesion, affecting the spinal root.

Disseminated cysticercosis incidentally diagnosed in a patient of low backache: A case report and concise review of literature

Disseminated cysticercosis is an uncommon presentation of a common disease. Asymptomatic disseminated cysticercosis is rarely reported in literature. Here, we are reporting a case of asymptomatic disseminated cysticercosis incidentally diagnosed in a patient of low backache. Magnetic resonance imaging of lumbosacral spine and neuroimaging done subsequently during the course of evaluation revealed diffuse cysticercosis involving abdominal, paraspinal, pelvic and gluteal muscles along with neurocysticercosis. Such a disseminated cysticercosis was diagnosed incidentally in this patient of low backache with right sciatica and radiculopathy at L5-S1 prolapsed intervertebral disc and was subsequently managed by L5-S1 interlaminar fenestration and discectomy.

Meningioma de células claras intra-espinal: Presentación de un caso y revisión de la literatura

Clear cell meningioma is a rare variety of meningiomas, occurring frequently at the cerebellopontine angle and spinal canal. A case of a female patient 28 years of age with a complete cauda equina syndrome was described. Magnetic resonance imaging of lumbo-sacral spine revealed a mass lesion occupying the spinal canal from L3 to S1. Subtotal resection was performed and pathological pathological examination revealed a clear cell meningioma. Radiotherapy was indicated, however, it was delayed because we discovered that the patient was pregnant. The recurrence was clinically evident at seven months and a new surgical resection previous complementary radiotherapy was necessary. A systematic review of literature was performed, exposing the behavior of clear cell meningioma in the spinal canal.