Sequestered Intradural Lumbar Disc

A 42-year-old farmer was lifting a hay bale and experienced a sudden onset of sharp pain radiating down his left leg. Over the ensuing week, the pain became less pronounced, but was replaced with a progressive left greater than right leg numbness, foot weakness, and urinary hesitancy. He presented to his local hospital, where he was initially managed conservatively, and then transferred to our institution for consultation after an MR lumbar spine was completed. On physical exam, he had grade 1/5 weakness of left and right dorsi- and plantar flexion. Sensory testing showed a moderate decrease in pinprick sensation in his left leg from L1 to S1 dermatomes. He was symmetrically hyporeflexic with grade 1 knee reflexes and absent ankle jerks. Peri-anal sensation was intact, but there was moderately reduced rectal tone. The remainder of his neurological exam was normal.

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In Vivo Lumbar Intervertebral Disc Deformation During Lateral Bending Motion Under Different Load-Bearing Conditions

10.21203/rs.3.rs-423428/v1 ◽

2021 ◽

Author(s):

Haoxiang Xu ◽

Wangqiang Wen ◽

Zepei Zhang ◽

Bowen Kou ◽

Jincheng Wu ◽

...

Keyword(s):

Lumbar Spine ◽

Intervertebral Disc ◽

Tensile Deformation ◽

Lumbar Disc ◽

Lateral Bending ◽

Lumbar Intervertebral Disc ◽

Load Bearing ◽

Compression Deformation ◽

Left And Right

Abstract Background Lumbar Intervertebral Disc Degeneration (LDD) is one of the largest health worldwide problems, based on lost working time and associated costs. Inappropriate mechanical loading is considered to be an important factor in the development of LDD. L3-4 and L4-L5 were the commonly affected levels. Recent studies have measured geometric deformation of lumbar intervertebral discs during an in vivo functional weightbearing of the lumbar. The purpose of the present study was to determine the lumbar disc deformation in living human subjects during lateral bending motion under different load-bearing conditions. Methods 11 healthy subjects, 6 males and 5 females, aged 21 ≤ 39 years, with an average age of 30 ± 5 years, were recruited for the present study. Using the combination of dual fluoroscopic imaging system(DFIS)and CT, the sagittal images of L3-5 segments scanned by CT were transformed into three-dimensional reconstruction models and then matched to the instantaneous images of lumbar spine motion taken by a double fluorescent X-ray system under different loads. Motions were reproduced with the use of the combined imaging technique during left and right bending movements. Then, the kinematics data of the height, tension and compression deformation, and shear deformation of the lumbar intervertebral disc were obtained by using computer-related software. Result The data indicated that the tendency of tensile deformation during left and right bending was approximately symmetric. During the functional bending of the body, there was a greater compression deformation behind the same side of the movement and a higher tension deformation in front of the contralateral movement. The magnitude changed along the diagonal towards the posterolateral direction. During left bending, the upper vertebrae had a larger deformation range and tension deformation than the lower vertebrae. Meanwhile, it was not found that the small load had a significant effect on the tensile deformation of the intervertebral disc. Conclusion Lumbar disc deformation showed direction-specific and level-specific changes during lateral bending motion. These results could help understand the physiological motion characters of the lumbar spine and provide data support for other biomechanical studies.

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Quantitative Sensory Testing and PET/CT Scanning in Assessment of Surgical Outcome for Lumbar Disc Herniation

Case Medical Research ◽

10.31525/ct1-nct03894943 ◽

2019 ◽

Author(s):

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Surgical Outcome ◽

Quantitative Sensory Testing ◽

Lumbar Disc ◽

Ct Scanning ◽

Sensory Testing ◽

Pet Ct

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Thermal quantitative sensory testing in lumbar disc herniation

European Spine Journal ◽

10.1007/s00586-001-0354-x ◽

2001 ◽

Vol 11 (1) ◽

pp. 71-75 ◽

Cited By ~ 16

Author(s):

L. Samuelsson ◽

A. Lundin

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Quantitative Sensory Testing ◽

Lumbar Disc ◽

Sensory Testing

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Thromboembolic Central Nervous System Complications of COVID-19

10.5327/1516-3180.492 ◽

2021 ◽

Author(s):

Caio Disserol ◽

Alessandra Filpo ◽

Taís Luise Denicol ◽

Bruno Della-Ripa ◽

Francine Mendonça ◽

...

Keyword(s):

Ct Angiography ◽

Holter Monitoring ◽

Sudden Onset ◽

Initial Assessment ◽

Nasopharyngeal Swab ◽

Sensory Level ◽

Csf Analysis ◽

Neurological Exam ◽

Diagnostic Work ◽

A Minor

Context: COVID-19 is well-known to increase the risk of developing thromboembolism; thus, patients may present with diverse neurovascular manifestations. Case report: A 56-year-old man presented with sudden onset of incoordination of his left arm and leg. He also had a history of recurrent episodes of transient left hemithoracic pain radiating to his left arm, along with right visual hemi-field positive phenomena. Additionally, he reported self-limited fever and anosmia three weeks earlier. Examination revealed left hemiataxia (NIHSS score: 2). Initial assessment with brain CT, intracranial and cervical CT angiography was normal. Shortly after admission, the patient developed acute weakness of his four limbs and urinary retention. Neurological exam showed left homonimous hemianopia, asymmetric tetraparesis and a superficial sensory level at C4. Neuraxis MRI was performed and diffusion-weighted imaging revealed acute ischemic lesions in the occiptal lobes, cerebellum and cervicalthoracic spine. A thorough diagnostic work-up was conducted. Laboratory tests were unremarkable, including inflammatory markers, viral hepatitis, HIV and syphilis serologies, as well as rheumatologic tests and a thrombophilia panel, except for SARS-COV-2 serology, with detection of IgM antibodies. RT-PCR nasopharyngeal swab was negative. Further investigation with CSF analysis, CT angiography of the aorta, transthoracic echocardiogram, 24-hour holter monitoring and transcranial Doppler didn’t show any abnormalities. Transesophageal echocardiogram revelead a minor patent foramen ovale. Conclusion: This is a case of acute cerebral, cerebellar and spinal embolic infarction, probably related to Covid-19, illustrating the infection’s associated coagulopathy¹.

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Biomechanical Effect of Lumbar Disc Degeneration Under Flexion/Extension: A Finite Element Model Study

ASME 2007 Summer Bioengineering Conference ◽

10.1115/sbc2007-176190 ◽

2007 ◽

Author(s):

Lissette M. Ruberté ◽

Raghu Natarajan ◽

Gunnar B. J. Andersson

Keyword(s):

Finite Element ◽

Lumbar Spine ◽

Finite Element Model ◽

Disc Degeneration ◽

Pathological Condition ◽

Lumbar Disc ◽

Element Model ◽

Adjacent Segment ◽

Lumbar Disc Degeneration ◽

Flexion Extension

Degenerative disc disease (DDD) is a progressive pathological condition observed in 60 to 80% of the population [1]. It involves changes in both the biochemistry and morphology of the intervertebral disc and is associated with chronic low back pain, sciatica and adult scoliosis [2,3]. The most accepted theory of the effects of DDD on the kinematics of the spine is that proposed by Kirkaldy-Willis and Farfan which states that the condition initiates as a temporary dysfunction, followed by instability and then re-stabilization as the disease progresses [4]. Although there is no clear relationship between disc degeneration and the mechanical behavior of the lumbar spine, abnormal motion patterns either in the form of increased motion or erratic motion have been reported from studies on human cadaveric motion segments [5,6]. To date however no study has looked at how disc degeneration affects the adjacent segment mechanics. IN vivo testing is difficult for these purposes given that specimens are generally obtained from people at the later stages of life and consequently often display multiple pathologies. A finite element model is a viable alternative to study the mechanics of the segments adjacent to the diseased disc. It is hypothesized that moderate degeneration at one level will alter the kinematics of the whole lumbar spine.

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