Routine Lumbar Spine Research Articles

Bone loss and the progression of abdominal aortic calcification over a 25 year period: the Framingham Heart Study.

Vascular calcification and osteoporosis are common age-related processes that are prominently displayed on routine lateral lumbar spine radiographs as dense calcium mineral deposits of the aorta that lie adjacent to osteopenic vertebrae. Using a population-based cohort of older men and women, we tested the hypothesis that the progression of vascular calcification of the abdominal aorta should be greatest in those individuals with the greatest amount of bone loss. From the original population-based Framingham Heart Study cohort, 364 women and 190 men had lateral lumbar spine and hand radiographs performed between 1966 and 1970 and repeated between 1992 and 1993. The lateral lumbar films were read for the presence of aortic calcification using a semiquantitative method, and the hand films were read for second metacarpal relative cortical area (MCA). Using multivariate regression techniques, the 25-year progression of the abdominal aortic calcification index was examined in relation to the change in the MCA, while adjusting for recognized risk factors for atherosclerotic cardiovascular disease. During the 25 years of follow-up, the MCA decreased by 22.4% in women (from 79.6 +/- 7.8 (SD) to 61.8 +/- 10.3) and by 13.3% in men (from 80.6 +/- 6.9 to 69.9 +/- 8.3). The aortic calcification score increased over eightfold in women (from 1.2 +/- 2.7 (SD) to 9.9 +/- 6.7) and sixfold in men (from 1.6 +/- 2.8 to 9.6 +/- 6.3). There was a significant association between percent change in MCA and change in aortic calcification index (P = 0.01) in women after controlling for all potential confounders. No association was observed in men (P = 0.50), including the 50% of men with the greatest bone loss. This is the first longitudinal study to show that women with the greatest magnitude of bone loss also demonstrate the most severe progression of abdominal aortic calcification, suggesting that the two processes may be related.

Urinary retention following routine neurosurgical spine procedures

Background The rate and duration of urinary retention after routine cervical and lumbar spine procedures were studied. METHODS Preoperative, intraoperative, and postoperative factors related to urinary retention (age, sex, duration of operation, medications, Foley use, hospital stay, and cost) were analyzed in a retrospective review of 503 patients’ charts. RESULTS Urinary retention occurred 38% of the time following cervical and lumbar spine procedures. Advanced age and preoperative β blockers contributed to a higher incidence of urinary retention. Preoperative anti-inflammatory medications and narcotic analgesics reduced the frequency of urinary retention. The duration of urinary retention was prolonged in older patients and patients who underwent intraoperative Foley catheterization. Urinary retention contributed to longer hospitalization and increased hospital costs. CONCLUSIONS Transient urinary retention is a common complication of routine neurosurgical spine procedures that prolongs hospital stays and increases the costs of hospitalization.

Lumbar spine radiology: analysis of the posteroanterior projection.

The use of the posteroanterior (PA) technique as a means of dose reduction has been used effectively in radiology departments for chest and abdominal examinations. The aim of this investigation was to establish if the PA lumbar spine projection offers any advantages over the traditional anteroposterior (AP) view in terms of radiation dose and image quality. The contribution of tissue displacement to any dose reduction was also evaluated. The first part of the study involved the use of an anthropological phantom where entrance surface and an internal dose were measured for both the PA and AP projections. Entrance surface doses for both projections were then measured on randomly allocated female patients. Resultant image quality was assessed using CEC quality criteria. Anterior to posterior patient diameter was also recorded. The results demonstrated that with the PA compared with the AP projection, reductions of 38.6% (p = 0.016) and 38.9% (p = 0.02) in patient entrance surface dose and internal phantom dose, respectively. No significant differences in image quality were noted between the two projections. Patient diameter decreased by 1.8 cm with the PA view. The authors conclude that tissue displacement is the main factor for the patient dose reduction and recommend employment of the PA procedure for routine lumbar spine examinations.

Comparison of dermatomal SEPs and operative findings in lumbar disc disease

This report deals with an estimation of the diagnostic value of dermatomal somatosensory evoked potentials (SEPs), by correlating the neurophysiological data to clinical, neuroradiological and operative findings in lumbar disc protrusion. Our material consists of 12, surgically treated patients with lumbar disc protrusion in which diagnostic work up included history, neurological examination, routine lumbar spine films, computerised tomography and MRI of the lumbar spine, in addition to neurophysiological investigation, especially conduction velocity studies, and SEPs recorded by the standard methods, as well as after dermatomal stimulation. The retrospective analysis disclosed a correlation for the SEPs after dermatomal stimulation and surgical findings, in 83% of our cases.

The effectiveness of treatment for the prolapsed lumbar intervertebral disc: A review of the literature

Literature relating to the management of prolapsed lumbar intervertebral discs was reviewed in order to assess the effectiveness of current medical care. Five aspects of care were addressed: the effectiveness of alternative forms of conservative treatment, the length of time necessary for a satisfactory trial of conservative management, the usefulness or otherwise of routine lumbar spine X-rays, the type of investigation best suited to confirm the nature and level of the lesion in cases where surgical intervention is considered and the form of intervention that provides the best outcome for the patient. Plain lumbar spine X-rays were found to be unnecessary as a routine investigation. All conservative treatment options were found to offer at most short-term benefit only and did not affect the long-term outcome. Computerized tomographic scans or magnetic resonance imaging are most suitable for providing confirmation of the level of the lesion. Myelograms should not be used routinely. Minimally invasive surgery appears to have the best outcomes and to be the most acceptable to the patient.

Spondylolysis and Spondylolisthesis in Military Parachutists

This paper reports on three cases of symptomatic low back pain in three paratroopers in association with bilateral L5 spondylolysis and L5 on S1 spondylolisthesis. The controversy regarding the etiology of this lesion as well as the problems of establishing causality when associated with parachuting injuries are discussed. These cases raise the issue of whether routine lumbar spine roentgenography should be performed as part of the pre-course medical screening prior to an individual undertaking basic parachutist training, and stress the need for further study of the relevance of these lesions in military parachuting.

Autogeneic fat transplants in the epidural space in routine lumbar spine surgery

Autogeneic fat transplants in the epidural space in routine lumbar spine surgery

Anteroposterior and lateral radiographs: an adequate lumbar spine examination.

A retrospective study was designed to determine the diagnostic value of spot lateral and oblique lumbar spine radiographs in 782 patients. In only 2.4% of patients examined were these views uniquely diagnostic. Considering the additional cost, significant gonadal radiation, and limited diagnostic value, these views should be eliminated from routine lumbar spine series.

Diskitis: A Prospective Diagnostic Analysis

In a three-year prospective analysis of nine patients with suspected diskitis, seven were confirmed as having diskitis, one had sacroiliac septic arthritis, and one had Guillain-Barré syndrome. The mean age of the patients was 3.3 years, and four of the seven were girls. Routine lumbar spine roentgenograms were not diagnostic for three to eight weeks. Nuclear imaging procedures, however, produced abnormal scans in all nine studies. Technetium Tc 99m diphosphonate scans were abnormal within seven days of symptoms, gallium citrate Ga 67 scans within 14 days. Scans were abnormal on seven occasions when standard roentgenograms were not diagnostic. The diskitis patients had low-grade fever (seven), irritability (six), and leg or hip complaints (six). Early, rapid diagnosis is critical with this disease because some cases have been misdiagnosed as meningitis, appendicitis, or septic arthritis. Four of the seven patients had evidence of viral disease, white β-hemolytic streptococci and anaerobic diphtheroids were isolated from two disk space aspirates. Spica casts were used in six patients to encourage immobilization, antibiotics in two, and one patient received no specific therapy. All patients recovered regardless of therapy. The present study is the first known prospective study of diskitis. The data thus far collected suggest that this disease is more common than previously recognized and that with the use of radiopharmaceuticals, cases previously missed may now be accurately diagnosed as diskitis. Pediatricians are urged to consider this diagnosis in any child with fever, irritability, and vague abdominal, leg, or back complaints whose origin is not identified.