LUMBAR SPINE STUDIES WITH IMPORTANT CLINICAL IMPLICATIONS

-

Study 1:

A novel 3D analyzing system for the relative motions of individual vertebrae using 3D MRI; analyzed 3D in vivo intervertebral motions of the lumbar spine during trunk rotation revealed following data:
3D MRI of the lumbar spine was done in 9 positions with 15 degrees increments during trunk rotation (0 degree, 15 degrees, 30 degrees, 45 degrees, and maximum).


1. The mean axial rotation of ten healthy volunteers of each lumbar spinal segment in 45 degrees trunk rotation to each side ranged from 1.2 degrees to 1.7 degrees.
2. Coupled flexion with axial rotation was observed at the segments from L1/2 to L5/S1.
3. Coupled lateral bending of the segments from L1/2 to L4/5 was in the opposite direction of the trunk rotation, while that of T12/L1 and L5/S1 was in the same direction.
4. The direction of the coupled lateral bending in the present study was different from that in the previous cadaver study only at L4/5.
Study 2:


Clinically, lumbosacral list is a common posture. Range of motion and spinal coupling results have not been reported for the lumbosacral list movement. A study determined lumbar coupling during lateral postural translations (lumbosacral list) of the thoracic cage relative to a fixed pelvis.
Four vertebral body corners, mid narrow-waisted body margins, superior and inferior pedicle margins, and spinous-lamina junction of T12-L5 were digitized on 51 anterior-posterior lumbar radiographs.
Using the orthogonal axes of positive x-direction to the left, vertical as positive y, and anterior as positive z, digitized points were used to measure projected segmental z-axis rotation, y-axis rotation, and segmental lateral translations of each vertebra.
Following key observation was marked using superior endplates to superior sacral base:

1. Lateral flexion was largest at L1 and decreased from L1 to L5,
2. But the segmental rotation angles for lateral flexion were largest at L2-L3 (3.9 degrees), L3-L4 (6.2 degrees) and L4-L5 (5.7 degrees) and were in the same direction as the main motion translation.
3. The relative z-axis rotation of T12 was opposite to the direction of L1-L5.
4. The coupled y-axis rotations were less than 1 degree and coupled segmental lateral translations were averaging less than 1 mm.
Clinical relevance of these studies:

These data may be useful for the optimal orthopaedic management of lumbar spinal disorders such as following:
1. The clinically common posture of lateral translation of the thoracic cage (lumbosacral list) is often associated with disc herniation. Yet normal lumbar coupling patterns and total range of motion of this movement have not been established in the literature.
2. Normal values for lumbar segmental coupling on anterior-posterior lumbo-pelvic radiographs during trunk list might be important for an analysis of segmental instability since segmental translations were determined to be 1 mm or less.

Comments

Post a Comment

Popular posts from this blog

Entrapment of medial calcaneal nerve (MCN)

-
Image
Peripheral nerve entrapment is a rare, but important, cause of foot and ankle pain that often is underdiagnosed and mistreated. A peripheral nerve may become entrapped anywhere along its course, but certain anatomic locations are characteristic (2). The medial calcaneal nerve (MCN) The Tibial nerve is called the planter nerve in the sole. The tibial nerve passes to the sole of the foot takes a turn on the medial side of the calcaneum is called MCN. The medial calcaneal nerve arises from tibial nerve of the inner side of the ankle, perforates the laciniate ligament, travels downwards passing below the bony projection on the inner side of the ankle, and supplies the skin over the medial aspect of the heel. Hence it is the most important nerve for heel sensations. MCN have 2 branches. The anterior branch dominate the cutaneous sensation of the anterior part of the medial calcaneal and heel weight loading field, while the posterior branch dominate the sensation of the posterior an...
Read more

Differential diagnosis of Anatomic (Radial) snuffbox pain: It is not always DeQuervain’s tenosynovitis.

-
Image
Tendon, Bone & Ligament causes: 1. DeQuervain’s tenosynovitis: Swelling of tendon of APL (Abductor pollicis longus) & extensor pollicis brevis at lateral wrist near anatomic snuff box.  The primary complaint is radial sided wrist pain that radiates up the forearm with grasping or extension of the thumb. The pain has been described as a “constant aching, burning, pulling sensation." Pain is often aggravated by repetitive lifting, gripping, or twisting motions of the hand. Swelling in the anatomical snuff box, tenderness at the radial styloid process, decreased CMC abduction ROM of the 1st digit, palpable thickening of the extensor sheaths of the 1st dorsal compartment and crepitus of the tendons moving from the extensor sheath may be found upon examination. Other possible findings include weakness and paresthesia in the hand. Finkelstein’s diagnostic test will present positive provoking the patient’s symptoms. If left untreated, the inflammation and progressive narro...
Read more

Chronic fatigue syndrome

-
Introduction: Severe fatigue is a common complaint among patients. Often, the fatigue is transient or can be attributed to a definable organic illness. Some patients present with persistent and disabling fatigue, but show no abnormalities on physical examination or screening laboratory tests. In these cases, the diagnosis of chronic fatigue syndrome (CFS) should be considered. According to Centers for Disease Control and Prevention (CDC, USA) Chronic fatigue syndrome (CFS) currently is defined as: (1) fatigue of at least 6 months' duration, seriously interfering with the patient's life; and (2) without evidence of various organic or psychiatric illnesses that can produce chronic fatigue. The World Health Organization classifies myalgic encephalomyelitis/chronic fatigue syndrome (ME/cfs) as a nervous system disease. Together with other diseases under the G93 heading, ME/cfs shares a triad of abnormalities involving elevated oxidative and nitrosative stress (O&NS), activat...
Read more