Palpation identification of spinous processes in the lumbar spine

Background: Any spine structure that is innervated by afferent nociceptive nerve fibers is a potential pain generator. In the lumbar spine, the most studied pain generators include: sacroiliac joints, the zygapophysial joints, the intervertebral discs, myofascial structures. Anomalous lumbosacral articulations, the spinous processes, and lumbar spine osteophytes are less commonly reported. Objective: To describe the diagnostic and therapeutic features of “kissing spine” disease or Baastrup’s Sign with particular attention to MRI findings and fluoroscopicallyguided injection therapy. Design: A series of 3 patients with axial low back pain presented with exam findings and MRI changes suggestive of pain emanating from adjacent spinous processes that appeared to be in direct contact or very closely opposed. This has been described in the literature as “kissing spine” disease or Baastrup’s sign. Fluoroscopically-guided injections were performed and the responses were studied. Results: The 3 patients had MRI findings consisting of inflammation and/or edema in the spinous processes and surrounding soft tissues. Fluoroscopically-guided injections provided pain relief in all 3 patients. One patient with recurrent pain eventually underwent successful surgical resection of the involved spinous processes. Conclusion: Painful adjacent and closely opposed spinous processes can be a source of axial low back pain. We have described MRI features and the responses to fluoroscopically-guided injections in 3 patients with this condition. Key words: Baastrup’s, kissing spine, spine injection

Download Full-text

The Interspinous Spacer: A Clinicoanatomical Investigation Using Plastination

Minimally Invasive Surgery ◽

10.1155/2012/538697 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Thomas Kaulhausen ◽

Kourosh Zarghooni ◽

Gregor Stein ◽

Jutta Knifka ◽

Peer Eysel ◽

...

Keyword(s):

Lumbar Spine ◽

Minimally Invasive ◽

Surgical Trauma ◽

Human Cadaver ◽

Neurogenic Intermittent Claudication ◽

Anterior Portion ◽

Spinous Processes ◽

Osseous Changes ◽

Surgical Implantation ◽

Lumbar Spinal

Purpose. The relatively new and less-invasive therapeutic alternative “interspinous process decompression device (IPD)” is expected to result in improved symptoms of neurogenic intermittent claudication (NIC) caused by lumbar spinal stenosis. The aim of the study was to analyze IPD position particularly regarding damage originating from surgical implantation.Methods. Anatomic assessments were performed on a fresh human cadaver. For the anatomic examination, the lumbar spine was plastinated after implantation of the IPDs. After radiographic control, serial 4 mm thick sections of the block plastinate were cut in the sagittal (L1–L3) and horizontal (L3–L5) planes. The macroanatomical positioning of the implants was then analyzed. The insertion procedure caused only little injury to osteoligamentous or muscular structures. The supraspinous ligament was completely intact, and the interspinous ligaments were not torn as was initially presupposed. No osseous changes at the spinal processes were apparent. Contact of the IPD with the spinous processes was visible, so that sufficient biomechanical limitation of the spinal extension seems likely.Conclusions. Minimally invasive IPD implantation with accurate positioning in the anterior portion of the interspinous place is possible without severe surgical trauma.

Download Full-text

Assessment of spine mobility in patients with ankylosing spondylitis by ultrasound scanning (preliminary data)

Modern Rheumatology Journal ◽

10.14412/1996-7012-2021-6-67-71 ◽

2021 ◽

Vol 15 (6) ◽

pp. 67-71

Author(s):

M. K. Kurbanmagomedov ◽

K. V. Sakharova ◽

A. B. Demina ◽

Sh. F. Erdes

Keyword(s):

Lumbar Spine ◽

Ankylosing Spondylitis ◽

Negative Relationship ◽

Analysis Data ◽

Initial Position ◽

Initial Examination ◽

Limited Mobility ◽

Spinous Processes ◽

Spine Mobility ◽

Spinal Ultrasound

Spine involvement in ankylosing spondylitis (AS) resulting in limited mobility requires a search for accurate, quantitatively methods of assessment of the decline of its function and monitoring of its dynamics. One of the promising methods for assessing movements in the spine in AS is ultrasound examination (US).Objective: to determine the relationship between the mobility of the spine measured sonographically, and the activity and functional status of patients with AS.Patients and methods. Spinal ultrasound was performed in 15 patients (10 men and 5 women, mean age 40.8±11.4 years, mean duration of the disease 5.5±3.5 years) with a confirmed diagnosis of AS, admitted to the V.A. Nasonova Research Institute of Rheumatology from April to August 2019. All patients underwent a double examination (at baseline and after 2 weeks) according to a specially developed protocol.Results and discussion. A comparative analysis of the results of sonographic measurements of the distance between the spinous processes of the vertebrae of the studied spine segment at baseline and after 2 weeks revealed a tendency towards an increase in these parameters both in the initial position and during flexion. There was no relationship between age, body mass index, duration of the disease and the distance between the spinous processes in all parts of the spine measured by sonography in initial position and during flexion. Correlation analysis data indicate the presence of a correlation between an increase in the distance between the spinous processes in the cervical and lumbar spine and a decrease in ESR, and i increase in the distance between the spinous processes in the lumbar spine and level of CRP. A weak negative relationship was found between the BASDAI index and the mobility of the spine at the LIV–V level and between sonographic measurements in all segment of the spine and the BASMI index.Conclusion. The sonographic method of determining the mobility of the spine can be recommended in patients with AS, both for initial examination and during follow-up, but it can't substitute the BASMI metrological index. Further research is needed to confirm the findings.

Download Full-text

Lumbar spine segmental instability in degenerative spine conditions

Science and Innovations in Medicine ◽

10.35693/2500-1388-2020-5-3-164-169 ◽

2020 ◽

Vol 5 (3) ◽

pp. 164-169

Author(s):

Aleksandr P. Fraerman ◽

Anton V. Yarikov ◽

Aleksandr O. Kotelnikov ◽

Igor I. Smirnov ◽

Vasilii A. Leonov ◽

...

Keyword(s):

Lumbar Spine ◽

Standing Position ◽

Spinal Instability ◽

Low Back ◽

Degenerative Spine ◽

Lateral Instability ◽

Segmental Instability ◽

Patient Complaints ◽

Spinous Processes ◽

Modern Methods

1240% of people with low back pain have spinal instability in degenerative-dystrophic diseases of the spine. The paper highlights the biomechanical basis for the development of segmental instability and discusses various hypotheses for the development of this condition. The authors describe the modern methods of neuroimaging used in the diagnosis of segmental instability, such as radiography, functional spondylography, CT, functional CT, MRI. Further, the paper presents provocative tests used in the diagnosis of instability: passive extension of the lumbar spine, standing, sitting, pron-instability, "scissors", compression of spinous processes, forward lean in standing position, and some others. The authors shared their experience in diagnosing segmental instability. However, the discrepancy between the data of instrumental examinations and patient complaints, poorly studied rotational and lateral instability in osteochondrosis indicate the need for a more detailed study of the instability of the spine as a whole.

Download Full-text

Reference data for interpreting widening between spinous processes in the lumbar spine

The Spine Journal ◽

10.1016/j.spinee.2011.02.005 ◽

2011 ◽

Vol 11 (4) ◽

pp. 336-339 ◽

Cited By ~ 2

Author(s):

Edward R. Jackson ◽

Ran Lador ◽

Peleg J. Ben-Galim ◽

Charles A. Reitman ◽

John A. Hipp

Keyword(s):

Lumbar Spine ◽

Reference Data ◽

Spinous Processes

Download Full-text

Impairment Tutorial: Recurrent Radioculpathy: Recurrent Radioculpathy and Apportionment

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2002.julaug03 ◽

2002 ◽

Vol 7 (4) ◽

pp. 8-10

Author(s):

Christopher R. Brigham ◽

Leon H. Ensalada

Keyword(s):

Lumbar Spine ◽

Range Of Motion ◽

Disk Herniation ◽

Fourth Edition ◽

Recurrent Injury ◽

Injury Model ◽

Whole Person ◽

Spinal Region

Abstract Recurrent radiculopathy is evaluated by a different approach in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, compared to that in the Fourth Edition. The AMA Guides, Fifth Edition, specifies several occasions on which the range-of-motion (ROM), not the Diagnosis-related estimates (DRE) method, is used to rate spinal impairments. For example, the AMA Guides, Fifth Edition, clarifies that ROM is used only for radiculopathy caused by a recurrent injury, including when there is new (recurrent) disk herniation or a recurrent injury in the same spinal region. In the AMA Guides, Fourth Edition, radiculopathy was rated using the Injury Model, which is termed the DRE method in the Fifth Edition. Also, in the Fourth Edition, for the lumbar spine all radiculopathies resulted in the same impairment (10% whole person permanent impairment), based on that edition's philosophy that radiculopathy is not quantifiable and, once present, is permanent. A rating of recurrent radiculopathy suggests the presence of a previous impairment rating and may require apportionment, which is the process of allocating causation among two or more factors that caused or significantly contributed to an injury and resulting impairment. A case example shows the divergent results following evaluation using the Injury Model (Fourth Edition) and the ROM Method (Fifth Edition) and concludes that revisions to the latter for rating permanent impairments of the spine often will lead to different results compared to using the Fourth Edition.

Download Full-text