One‐Stage Anterior Approach with Arch Plate to Treat Lumbosacral Tuberculosis

This article describes the arch plate technique for treating lumbosacral tuberculosis. Lumbosacral tuberculosis often leads to the destruction of anterior vertebral columns and presacral or iliopsoas abscess, which requires an anterior approach to achieve thorough debridement. Due to the complexity of the anatomical structure of lumbosacral spine and the high requirement of fixation stability, a combined posterior approach to perform internal fixation is necessary, which is rather traumatic. On the other hand, most of the current anterior lumbosacral internal fixation systems cannot be applied to spinal tuberculosis patients who have irregular bony endplate destruction. The arch plate was designed as a cephalic narrow and caudal wide trapezoid or triangle outline according to the preliminary anatomic research. In terms of the endplate bony destruction, a multidirectional technique was introduced in the arch screws, which enables surgeons to arbitrarily change the direction of the screw in the range of 5°–20°, which increases the length and the inclination angles in the sagittal plane of the implant screw and makes sure that the autologous iliac bone graft fits the irregular bone destruction for maximum stability. This study demonstrated the effectiveness of one‐stage anterior debridement, bone grafting, and arch plate fixation to treat lumbosacral tuberculosis. The risk of intraoperative and postoperative complications, such as injury to major vessels, could be minimized. This surgical procedure had many advantages, including a shorter operation time, less blood loss, and better functional recovery over the conventional combined anterior and posterior approach.     

No increase in 6-week treatment effect of Mechanical Diagnosis and Therapy with the use of the LUMOback in people with non-acute non-specific low back pain and a directional preference of extension: a pilot randomized controlled trial

Objectives

To pilot the methods for a randomized controlled trial (RCT) to investigate whether the treatment effect of Mechanical Diagnosis and Therapy (MDT) is enhanced with the LUMOback.

髂腰韧带的横断位CT表现及其在腰骶部椎体节段定位中的价值

目的：初步研究髂腰韧带的横断位CT表现,重点探讨髂腰韧带在腰骶段移行椎中的定位作用。方法：选2008年5月至2010年3月因腰背部症状拟诊椎间盘病变来院行CT扫描的706例患者,其中男436例,女270例;年龄25～82岁,平均44岁。所有患者均进行单层螺旋CT横断位扫描,其中移行椎患者78例,均经X线摄片或透视证实。在横断面CT图像上观察髂腰韧带的形态、位置及走行,了解其位置是否相对恒定;研究髂腰韧带与腰椎节段的关系,并与另外4种常用的腰骶椎节段CT定位方法作对照。结果：628例具有正常腰骶节段的患者其髂腰韧带的主要部分均起自L₅横突,止于髂嵴,3例可见髂腰韧带细小分支从L_4,5椎间盘后外缘同时发出,其形态可分双束型占71.8%(451/628)及单束型占28.2%(177/628);78例移行椎患者的髂腰韧带亦起源于L₅横突;以髂腰韧带作为L₅椎体水平的定位标记,均得到准确定位,其准确率明显高于其他定位方法,与髂嵴定位法比较差异具有统计学意义(P<0.05).结论：髂腰韧带主体起源于L₅横突,其解剖位置相对恒定,可将其作为L₅的解剖定位标志,以判断腰骶部移行椎类型和进行椎间盘定位。     

Staggered rhizotomy of anterior and posterior sacral roots for bladder reservoir function in spinal cord injury: a canine experimental study and preliminary clinical report

Objective: To report an experimental study and preliminary clinical results of staggered anterior and posterior sacral rhizotomy for restoring function of the bladder and preventing reflex incontinence in supra‐conal spinal cord injury (SCI). Methods: Ten T10 spinal cord transected mongrel dogs were divided into three groups. In group 1 (n= 2), laminectomy only was performed (control). In group 2 (n= 4), all L7‐S3 posterior roots were microsurgically cut (complete deafferentation). And in group 3 (n= 4), the L7, S1, S3 posterior roots and S2 anterior root were cut (staggered deafferentation and deefferentation). Intraoperative electrical stimulation and postoperative cystometrography (CMG) were carried out. In the clinic, three patients with spastic bladder caused by a supra conal complete SCI underwent staggered rhizotomy and were followed up for 6 years. Results: In the canine experimental study, resection of the S2 anterior root combined with L7, S1 and S3 posterior rhizotomy, stimulating the S2 posterior root (four dogs) resulted in a minimal rise in pressure in the bladder and urethra, which was only about 10% of that obtained by stimulating the S2 proximal posterior root while its anterior counterpart was intact (eight dogs, Student's t‐test, P < 0.01). The CMG study showed that groups 2 and 3 had similar volume/pressure curves; in both groups the tendency was to develop flaccid bladders. In the clinic, three cases underwent staggered rhizotomy of the anterior and posterior roots in S3 and S4. Good bladder reservoir and compliance was achieved over six years of follow‐up. Conclusion: Staggered rhizotomy of the anterior and posterior sacral roots at different spinal cord levels has the same denervation effect as a complete posterior rhizotomy, and good bladder reservoir function can be achieved by this procedure.     

Traumatic dislocation of the lumbosacral junction diagnosis, anatomical classification and surgical strategy

PURPOSE OF THE STUDY: Traumatic lumbosacral dislocation is a rare lesion often characterised by a fracture dislocation of L5-S1 articular facets associated with anterior L5 slipping. Because of its rarity, the surgical strategy of lumbosacral traumatic dislocation remains controversial. We report the most important series of traumatic lumbosacral dislocation. The cases of six men and five women are presented. We discuss the diagnosis and surgical treatment options regarding the different type of lesions. A moderate anterior slipping of L5 over S1 was present in eight cases. The lesion was a bilateral lumbosacral fracture dislocation in eight cases, a pure lateral dislocation in two cases and a unilateral rotatory dislocation in one case. Patients were multiple-trauma patients in eight cases. A radicular deficit was present in two cases. All patients were treated surgically with a posterior osteosynthesis and fusion. A circumferential fusion was made in six cases. In four cases, the anterior fusion was made during the posterior approach. The postoperative course was favorable in all the cases. One patient necessitated secondarily an iterative posterior lumbosacral fixation and anterior fibular bone graft because of a lumbosacral pseudarthrosis. Traumatic dislocation of the lumbosacral junction is a rare and severe spinal fracture which occurs in patients after high energy trauma and could be initially misdiagnosed. We devised a new classification based on anatomical lesions. Treatment is always surgical, requiring reduction, osteosynthesis, and fusion. In case of L5 anterior slipping, it is crucial to assess the L5S1 disc by MRI or surgical exploration for disc disruption. In such case, we recommend to perform circumferential fusion to prevent lumbosacral pseudarthrodesis.     

腰骶丛及分支神经阻滞对膝骨性关节炎关节腔液细胞因子含量的影响

目的探讨腰骶丛及其分支神经阻滞对膝关节骨性关节炎关节腔液细胞因子含量变化的影响。方法采集膝骨性关节炎7例患者治疗前和治疗后两周关节腔液,检测白细胞介素-1β（IL-1β）、肿瘤坏死因子-α（TNF-α）、一氧化氮（NO）及丙二醛（MDA）的含量。结果在神经阻滞两周后IL-1β、TNF-α和N0显著降低（P〈O．01）,MDA明显降低（P〈0．05）。结论IL-1β,TNF-α,NO和MDA在膝骨性关节炎的发生中具有重要的病理生理作用,神经阻滞疗法可能通过降低细胞因子的含量具有抗炎和保护关节软骨的作用。     

Measuring health in patients with cervical and lumbosacral spinal disorders: is the 12-item short-form health survey a valid alternative for the 36-item short-form health survey?

Lee CE, Browell LM, Jones DL. Measuring health in patients with cervical and lumbosacral spinal disorders: is the 12-Item Short-Form Health Survey a valid alternative for the 36-Item Short-Form Health Survey?

Objectives

To determine the convergent validity of the 12-Item Short-Form Health Survey, version 2 (SF-12v2), with 36-Item Short-Form Health Survey, version 2 (SF-36v2), in patients with spinal disorders, and to determine other key factors that might further explain the variances between the 2 surveys.

Design

Cross-sectional study.

Setting

Orthopedic ambulatory care.

Participants

Eligible participants (N=98; 24 with cervical, 74 with lumbosacral disorders) who were aged 18 years and older, scheduled to undergo spinal surgery, and completed the SF-36v2.

Interventions

Not applicable.

Main Outcome Measures

SF-36v2 and SF-12v2 (extracted from the SF-36v2).

Results

The 2 summary scores, physical and mental component scores (r range, .88-.97), and most of the scale scores (r range, .81-.99) correlated strongly between the SF-12v2 and SF-36v2, except for the general health score (cervical group, r=.69; lumbosacral group, r=.76). Stepwise linear regression analyses showed the SF-12v2 general health scores (cervical: β=.61, P<.001; lumbosacral: β=.68, P<.001) and the level of comorbidities (cervical: β=−.37, P=.014; lumbosacral: β=−.18, P=.039) were significant predictors of the SF-36v2 general health score in both groups, whereas age (β=.32, P<.001) and smoking history (β=−.22, P=.005) were additional predictors in the lumbosacral group.

Conclusions

SF-12v2 is a practical and valid alternative for the SF-36v2 in measuring health of patients with cervical or lumbosacral spinal disorders. The validity of the SF-12v2 general health score interpretation is further improved when the level of comorbidities, age, and smoking history are taken into consideration.     

Traumatic lumbosacral lateral dislocation without fracture

Study design  A unique case of lumbosacral lateral dislocation without fracture is reported. Objective  To report on the diagnosis and treatment of a traumatic L5-S1 lateral dislocation in a polytrauma 34-year-old male with L5 nerve root paralysis. Method  Interbody fusion following decompression, posterior reduction and interbody grafting combined with posterior plating was performed. Results  At an early stage the patient was able to return to work and walk without supports. At the 12-month follow-up evaluation no back pain was referred and fusion was achieved. Conclusions  Lateral pure dislocation of the lumbosacral joint is very rare and can be easily misdiagnosed. A careful evaluation of the AP standard X-ray can lead to diagnosis and can be confirmed by CT scan. Prompt reduction and fusion is the treatment of choice to allow a quick functional recovery.     

AMPA glutamatergic receptor-immunoreactive subunits are expressed in lumbosacral neurons of the spinal cord and neurons of the dorsal root and pelvic ganglia controlling pelvic functions in the rat

Sacral preganglionic neurons innervate the pelvic organs via a relay in the major pelvic ganglion. Pudendal motoneurons innervate striated muscles and sphincters of the lower urinary, genital and digestive tracts. The activity of these spinal neurons is regulated by sensory afferents of visceral and somatic origins. Glutamate is released by sensory afferents in the spinal cord, and interacts with a variety of receptor subtypes. The aim of the present study was to investigated the presence of AMPA glutamate receptor subunits (GluR1-GluR4) in the neural network controlling the lower urogenital and digestive tracts of male rats. We performed double-immunohistochemistry directed against a neuronal tracer, the cholera toxin beta subunit (Ctbeta) and each of the four receptor subunits. GluR1, GluR2 and GluR3 subunits were present in many sacral preganglionic neurons retrogradely labelled with Ctbeta applied to the pelvic nerve, and in some dorsolateral and dorsomedian motoneurons retrogradely labelled with Ctbeta injected in ischiocavernosus and bulbospongiosus muscles. The four subunits were detected in postganglionic neurons of the major pelvic ganglion retrogradely labelled with Ctbeta injected in the corpus cavernosum, and in some somata of sensory afferents of the L6 dorsal root ganglion labelled with Ctbeta applied to the dorsal penile nerve or injected in corpus cavernosum. The results provide a detailed knowledge of the neural targets expressing the various AMPA receptor subunits and suggest that part of the neural network that controls pelvic organs, including sensory afferents and postganglionic neurons, is sensitive to glutamate through the whole family of AMPA subunits.