CS-06 A CASE OF GLIOBLASTOMA METASTATIC TO THE LUMBAR VERTEBRA

Abstract BACKGROUND Most cases of glioblastoma recur within one year even under the standard treatment of surgical resection, radiation therapy and chemotherapy. 60–70% of recurrences are local, and in rare cases of metastasis, most are within the CNS. Extradural metastasis is considered exceedingly rare. CASE REPORT We present a 21-year-old man post total resection of right parietal lobe glioblastoma, diagnosed with lumber metastasis. He originally presented with impaired consciousness and left hemiplegia at the age of 20 and underwent gross total resection of the tumor. Pathology was IDH wild type, H3F3A K34R/V wild-type glioblastoma. Radiotherapy and adjuvant temozolomide per the Stupp regimen as well as infusion of bevacizumab were conducted. 6 months after the resection of tumor, the patient presented with severe back pain. Radiographic studies showed an osteolytic mass on the first lumbar vertebrae, and needle biopsy was consistent with glioblastoma. Posterior spinal fusion, internal decompression and radiotherapy were conducted to relieve the pain. At 3 months after the diagnosis of lumbar metastasis, he is currently treated with temozolomide and bevacizumab, without the enlarging of the tumor. DISCUSSION As far as we investigated, there has been 30 cases of vertebral metastasis of glioblastoma reported in literature. Considering the biological obstacles that prevent glioblastomas from infiltrating outside of the CNS, it can be speculated that deposition of tumor cells into the blood stream or excision of the dura due to surgical interventions may attribute to extracranial metastasis. Due to the improvement of overall survival of glioblastoma, vertebral metastasis is suspected to be more common. Therefore, investigation of its risk factors and standardization of its treatment is necessary. CONCLUSION We reported a case of lumbar metastasis of glioblastoma. Extradural metastasis of glioblastoma must be included in differential diagnoses in treating patients with glioblastoma.

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Influence of supramarginal resection on survival outcomes after gross-total resection of IDH–wild-type glioblastoma

Journal of Neurosurgery ◽

10.3171/2020.10.jns203366 ◽

2021 ◽

pp. 1-8

Author(s):

Tito Vivas-Buitrago ◽

Ricardo A. Domingo ◽

Shashwat Tripathi ◽

Gaetano De Biase ◽

Desmond Brown ◽

...

Keyword(s):

Significant Influence ◽

Karnofsky Performance Status ◽

Performance Status ◽

Gross Total Resection ◽

Inclusion Criteria ◽

Wild Type ◽

Total Resection ◽

Contrast Enhanced ◽

Observational Cohort ◽

Supramarginal Resection

OBJECTIVE The authors’ goal was to use a multicenter, observational cohort study to determine whether supramarginal resection (SMR) of FLAIR-hyperintense tumor beyond the contrast-enhanced (CE) area influences the overall survival (OS) of patients with isocitrate dehydrogenase–wild-type (IDH-wt) glioblastoma after gross-total resection (GTR). METHODS The medical records of 888 patients aged ≥ 18 years who underwent resection of GBM between January 2011 and December 2017 were reviewed. Volumetric measurements of the CE tumor and surrounding FLAIR-hyperintense tumor were performed, clinical variables were obtained, and associations with OS were analyzed. RESULTS In total, 101 patients with newly diagnosed IDH-wt GBM who underwent GTR of the CE tumor met the inclusion criteria. In multivariate analysis, age ≥ 65 years (HR 1.97; 95% CI 1.01–2.56; p < 0.001) and contact with the lateral ventricles (HR 1.59; 95% CI 1.13–1.78; p = 0.025) were associated with shorter OS, but preoperative Karnofsky Performance Status ≥ 70 (HR 0.47; 95% CI 0.27–0.89; p = 0.006), MGMT promotor methylation (HR 0.63; 95% CI 0.52–0.99; p = 0.044), and increased percentage of SMR (HR 0.99; 95% CI 0.98–0.99; p = 0.02) were associated with longer OS. Finally, 20% SMR was the minimum percentage associated with beneficial OS (HR 0.56; 95% CI 0.35–0.89; p = 0.01), but > 60% SMR had no significant influence (HR 0.74; 95% CI 0.45–1.21; p = 0.234). CONCLUSIONS SMR is associated with improved OS in patients with IDH-wt GBM who undergo GTR of CE tumor. At least 20% SMR of the CE tumor was associated with beneficial OS, but greater than 60% SMR had no significant influence on OS.

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Abstract 15673: CRISPR-Cas9 Gene Editing in Mice Reveals Novel Thrombotic Function of a Human SNP in STXBP5

Circulation ◽

10.1161/circ.132.suppl_3.15673 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Qiuyu Zhu ◽

Kyung Ae Ko ◽

Sara Ture ◽

Craig N Morrell ◽

Joseph M Miano ◽

...

Keyword(s):

Endothelial Cells ◽

Gene Editing ◽

Association Studies ◽

Blood Stream ◽

Genome Wide Association Studies ◽

Wild Type ◽

Human Endothelial Cells ◽

Mesenteric Vessel ◽

Prolonged Bleeding Time ◽

Bleeding Score

Introduction: Endothelial cells responds to vascular injury by exocytosis, releasing von Willebrand factor (vWF) into the blood stream. However, the regulation of endothelial vWF release remains poorly understood. Recent genome-wide association studies (GWAS) have identified syntaxin-binding protein 5 (STXBP5) as a candidate gene linked to changes in vWF plasma levels. One top nonsynonymous single nucleotide polymorphism (SNP), rs1039084 (hg19 chr6:g.147635413A>G), encodes p. Asn436Ser substitution (STXBP5-N436S), and is associated with lower plasma vWF, higher bleeding score, and decreased venous thrombosis in humans. We recently discovered that STXBP5 inhibits endothelial vWF exocytosis and regulates thrombosis. However, the role of the STXBP5 genetic variants linked to vWF levels are not completely understood. Hypothesis: We hypothesized that STXBP5-N436S further inhibits endothelial exocytosis than wild type (STXBP5-WT). Methods: We overexpressed STXBP5-WT and STXBP5-N436S in cultured human endothelial cells and measured VWF release changes. Using CRISPR-Cas9 technique, we generated mice carrying the human rs1039084 SNP in Stxbp5 locus (Stxbp5-N437S mice). We conducted phenotypic analyses including endothelial exocytosis, hemostasis, and thrombosis in wild-type and Stxbp5-N437S mice. Results: In human endothelial cells, overexpression of STXBP5-N436S inhibits vWF exocytosis more potently than STXBP5-WT. Germline CRISPR-Cas9 gene editing efficiently and precisely knocked-in the human rs1039084 SNP in murine Stxbp5 locus, without causing detectable off-target genome cleavage. The baseline plasma vWF levels of Stxbp5-N437S mice are similar to WT mice, but Stxbp5-N437S mice showed impaired vWF exocytosis in response to epinephrine challenge. Moreover, Stxbp5-N437S mice have severe hemostasis defects displayed as prolonged bleeding time. Finally, Stxbp5-N437S mice have impaired mesenteric vessel thrombosis and carotid artery thrombosis. We are now studying the effects of the SNP upon STXBP5 structure and function. Conclusions: Our study validates the functional relevance of a candidate SNP identified by GWAS, and suggests that genetic variations within STXBP5 is a risk factor for thromboembolic disease.

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Dermatomyotomal supply in patients with variations in the number of lumbar vertebrae

Journal of Neurosurgery Spine ◽

10.3171/2009.9.spine09114 ◽

2010 ◽

Vol 12 (3) ◽

pp. 314-319 ◽

Cited By ~ 4

Author(s):

Michael Kottlors ◽

Franz Xaver Glocker

Keyword(s):

Disc Herniation ◽

Nerve Root ◽

Lumbar Vertebrae ◽

Lumbar Vertebra ◽

Motor Deficit ◽

Sacral Vertebra ◽

Imaging Data ◽

Nerve Roots ◽

Lumbar Nerve Root ◽

Electrophysiological Examination

Object Variation in the number of lumbar vertebrae occurs in a small portion of the population. Either the fifth lumbar vertebra shows assimilation to the sacrum or the first sacral vertebra shows a lumbar configuration, resulting in 4 or 6 lumbar vertebrae, respectively. Etiologically, lumbar nerve root syndrome is diagnosed by comparing the anatomical level of the disc herniation to the compressed nerve root and to the pattern of the peripheral sensory and motor deficit. In case of a variation in the number of lumbar vertebrae, defining the lumbar nerve roots becomes difficult. Variations in the number of lumbar vertebrae make the landmarks (the twelfth rib and the first sacral vertebra) unreliable clues to define the nerve roots. The allocation of the clinically damaged segment to the spinal disorder seen in imaging studies is essential for differential diagnosis and spine surgery. Methods A retrospective study was conducted of clinical, electrophysiological, and imaging data among inpatients over a period of 21 months. Eight patients who had isolated monosegmental discogenic nerve root compression and a variation in the number of lumbar vertebrae were selected. Results Seven patients presented with 6 lumbar vertebrae, and 1 patient presented with 4 lumbar vertebrae and disc herniation on 1 of the 2 caudal levels. Compression of the second-to-last nerve root in patients with 6 lumbar vertebrae resulted either in clinical L-5 or S-1 syndrome, or a combination of both. Compression of the last caudal nerve root resulted in a clinical S-1 nerve root syndrome. Conclusions The findings suggest that the dermatomyotomal supply of the lumbosacral nerve roots can vary in patients with a variation in the number of lumbar vertebrae, and a meticulous clinical, radiological, and electrophysiological examination is essential.

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Steinmann Pins and Polymethylmethacrylate Repair of Fourth Lumbar Vertebral Fracture and Dorsocranial Luxation in PuppySteinmann Pins and Polymethylmethacrylate Repair of Fourth Lumbar Vertebral Fracture and Dorsocranial Luxation in Puppy

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.101899 ◽

2020 ◽

Vol 48 ◽

Author(s):

Fernando Bezerra Da Silva Sobrinho ◽

Ivan Felismino Charas Dos Santos ◽

Claudia Valéria Seullner Brandão ◽

Sheila Canevese Rahal ◽

César Passareli Cândido Lobo ◽

...

Keyword(s):

Spinal Cord ◽

Surgical Treatment ◽

Vertebral Fracture ◽

Lumbar Vertebrae ◽

Lumbar Vertebra ◽

The Body ◽

Labrador Retriever ◽

Lumbar Vertebral Fracture ◽

Cord Injury ◽

Fourth Lumbar Vertebra

Background: Acute spinal traumas can lead to irreversible damage associated with vascular and inflammatory changes in neural tissue. Since spine and spinal cord traumas have an unfavorable prognosis in small animals, and reports of the use of Steinmann pins and polymethylmethacrylate repair of lumbar vertebra fracture-luxation in puppies are rare in the literature, the present paper aimed to report the surgical treatment of transversal fracture through the body of the fourth lumbar vertebra, with dorsocranial displacement of the caudal fragment by using Steinmann pins and polymethylmethacrylate in a 7-month-old Labrador Retriever male dog.Case: A 7-month-old intact male Labrador Retriever dog, weighing 24.0 kg was attended at School Veterinary Hospital with a history of hit by car and paraplegia of the hind limbs. On neurological examination was observed no proprioception and no deep pain sensitivity on the both pelvic limbs. The lumbar spinal palpation showed intense pain, and the motor function and patellar reflexes were reduced. The values of haematological and biochemical analysis remained within the reference values for the species. Radiographs revealed a transversal fracture through the body of the fourth lumbar vertebra, with dorsocranial displacement of the caudal fragment, and was decided to perform a surgical treatment by open reduction and internal fixation of the fracture. The dog was positioned in ventral recumbency for surgery, and a dorsal midline incision was made from the second lumbar vertebra to the sixth lumbar vertebra. Two crossed 1.5 mm Kirschner wires were placed through the caudal articular facets of the fourth lumbar vertebra to provide initial stability. Two 2.0 mm Steinmann pins were placed at 60° angle of the bodies of the second and fifth lumbar vertebrae, and third and fourth lumbar vertebrae. This procedure was repeated on the other side of the vertebral bodies. Sixty grams of polymethylmethacrylate bone cement was applied and the fixation was checked for stability. Muscular, subcutaneous tissue and skin was closed routinely. The dog was paraplegic without any pain and used a wheelchair to assist in locomotion, although it still had urinary and faecal incontinence; no tail control; and the implants were not removed.Discussion: Lumbar vertebral injuries, as in the present case frequently, occur secondary to severe trauma (e.g. hit by car) and seem to have a characteristic fracture pattern. The patient became paraplegic due to spinal cord injury and failure of sensitivity and elimination of urine and feces which can be associated with progressive destruction of neuronal tissue due to secondary vascular and inflammatory events. The radiographic exam was used to confirm the spinal injury and determine whether by conservative or surgical treatment. The treatment choice is related to the number of fractured compartments, and the presence or not of compression. Fractures in two or more compartments are indicative of surgical treatment, similar as the present case. Use of Steinmann pins was to make a rigid fixing system compared with block plates used for the same function. Use of polymethylmethacrylate may also become a complication due to the infection, for this reason was prescribed an antibiotic for 15 days. This procedure proved to be effective since the dog showed no signs of infection. According to the characteristics of the present case report, the use of Steinmann pins and polymethylmethacrylate for repair of transversal fracture through the body of the fourth lumbar vertebra, with dorsocranial displacement of the caudal fragment provided an effective and practical means of stabilisation, promoting decompression, and thus, improving the patient's quality of life.

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The Effectiveness of the Amount of Polymethylmethacrylate In The Treatment of Osteoporotic Compression Fracture of The Lumbar Vertebrae

Bakirkoy Tip Dergisi / Medical Journal of Bakirkoy ◽

10.5222/bmj.2020.19483 ◽

2020 ◽

Author(s):

Mehmet Onur Yüksel ◽

Serdar Çevik ◽

Barış Erdoğan ◽

Salim Katar ◽

Tamer Tunçkale ◽

...

Keyword(s):

Visual Analogue Scale ◽

Pain Control ◽

Analogue Scale ◽

Percutaneous Vertebroplasty ◽

Lumbar Vertebrae ◽

Compression Fracture ◽

Lumbar Vertebra ◽

Vertebral Height ◽

Osteoporotic Compression Fracture ◽

The Mean

Objective: We aimed to investigate the effectiveness of the amount of polymethylmethacrylate used in pain control and maintenance of long-term vertebra corpus height in patients undergoing percutaneous vertebroplasty due to osteoporotic compression fracture of the lumbar vertebra. Method: A total of 60 patients who underwent unilateral percutaneous vertebroplasty between 2014 and 2019 due to osteoporotic compression fracture of the lumbar vertebrae were included in the study. Patients who received 5 ml and 3 ml cement injection were retrospectively analyzed. Of patients, postoperative visual analogue scale (VAS) score and anterior vertebral height of the patients at 1st-year control were evaluated. Results: In the postoperative period, the mean visual analogue scale score was 2.3±0.46 in the 5 ml injected group and 2.2±0.4 in the 3 ml injected group (p5 ml=0.001, p3 ml= 0.001). There was a statistically significant decline in pain control in both groups. The mean anterior vertebral height loss (AVHL) in the 5 ml injected group was 31.5±0.40%, and 32.6±0.47% in the 3 ml injected group (p5 ml=0.820, p3ml= 0.870). There was no statistically significant alteration in both groups. Conclusion: Our results indicate that the 3 ml polymethylmethacrylate injection during the percutaneous vertebroplasty procedure provides adequate pain control and stabilization in patients with lumbar vertebral osteoporotic fracture. Therefore we think that small amount of polymethylmethacrylate (3 ml) is sufficient to avoid undesirable complications in this patient group.

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Estimating age from digital radiographic images of lumbar vertebrae in a Thai population using an image analysis technique

Medicine Science and the Law ◽

10.1177/00258024211062027 ◽

2021 ◽

pp. 002580242110620

Author(s):

Yanumart Malatong ◽

Patison Palee ◽

Apichat Sinthubua ◽

Sakarat Na Lampang ◽

Pasuk Mahakkanukrauh

Keyword(s):

Image Analysis ◽

Linear Regression ◽

Age Estimation ◽

Lumbar Vertebrae ◽

Lumbar Vertebra ◽

Analysis Method ◽

Image Analysis Method ◽

Thai Population ◽

Radiographic Images ◽

Black Pixel

Using the lumbar vertebra for age estimation is helpful in cases when skeletal remains are incomplete and typical skeletal age indicators are absent. This study aimed to apply an image analysis method in extracting black pixel variables for age estimation by using the radiographic images of lumbar vertebra in a Thai population. All lumbar vertebrae L1–L5 of 220 (110 males and 110 females) from Thai individuals of known sex and ages were studied. The variables of Total Percentage of black pixels (TP), Mean Percentage of black pixels (MP), and Ratio of black to white pixels (BW), were calculated to assess the relationship between black pixel variables and aging. Equations were formulated using linear regression analysis. The results of this study indicated three variables of the lumbar vertebrae had significantly positive correlations with age. The correlation between parameters with age in males ranged 0.211–0.419, while the range in females was 0.219–0.458. The appropriate linear regression equation with the total and mean percentages of black pixel variables shows Age = −1.348+0.871 (TP) +0.514 (MP) of L4 for males (SEE; 15.4 years), and Age = 5.338 +0.316 (TP) +0.952 (MP) of L1 for females (SEE; 13.8 years). Age estimation using an image analysis method is an alternative to investigating the trabecular structure. The black pixel variable is not the actual value of bone density. However, it is useful to study its relationship with aging.

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Stereotactic radiosurgery for glioblastoma considering tumor genetic profiles: an international multicenter study

Journal of Neurosurgery ◽

10.3171/2021.7.jns211277 ◽

2021 ◽

pp. 1-9

Author(s):

Adomas Bunevicius ◽

Stylianos Pikis ◽

Douglas Kondziolka ◽

Dev N. Patel ◽

Kenneth Bernstein ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Local Control ◽

Methylation Status ◽

Idh Mutation ◽

Mgmt Methylation ◽

Wild Type ◽

Total Resection ◽

Treatment Volume ◽

Prescription Dose ◽

Molecular Profiles

OBJECTIVE Molecular profiles, such as isocitrate dehydrogenase (IDH) mutation and O6-methylguanine-DNA methyltransferase (MGMT) methylation status, have important prognostic roles for glioblastoma patients. The authors studied the efficacy and safety of stereotactic radiosurgery (SRS) for glioblastoma patients with consideration of molecular tumor profiles. METHODS For this retrospective observational multiinstitutional study, the authors pooled consecutive patients who were treated using SRS for glioblastoma at eight institutions participating in the International Radiosurgery Research Foundation. They evaluated predictors of overall and progression-free survival with consideration of IDH mutation and MGMT methylation status. RESULTS Ninety-six patients (median age 56 years) underwent SRS (median dose 15 Gy and median treatment volume 5.53 cm3) at 147 tumor sites (range 1 to 7). The majority of patients underwent prior fractionated radiation therapy (92%) and temozolomide chemotherapy (98%). Most patients were treated at recurrence (85%), and boost SRS was used for 12% of patients. The majority of patients harbored IDH wild-type (82%) and MGMT-methylated (62%) tumors. Molecular data were unavailable for 33 patients. Median survival durations after SRS were similar between patients harboring IDH wild-type tumors and those with IDH mutant tumors (9.0 months vs 11 months, respectively), as well as between those with MGMT-methylated tumors and those with MGMT-unmethylated tumors (9.8 vs. 9.0 months, respectively). Prescription dose > 15 Gy (OR 0.367, 95% CI 0.190–0.709, p = 0.003) and treatment volume > 5 cm3 (OR 1.036, 95% CI 1.007–1.065, p = 0.014) predicted overall survival after controlling for age and IDH status. Treatment volume > 5 cm3 (OR 2.215, 95% CI 1.159–4.234, p = 0.02) and absence of gross-total resection (OR 0.403, 95% CI 0.208–0.781, p = 0.007) were associated with inferior local control of SRS-treated lesions in multivariate models. Nine patients experienced adverse radiation events after SRS, and 7 patients developed radiation necrosis at 59 to 395 days after SRS. CONCLUSIONS Post-SRS survival was similar as a function of IDH mutation and MGMT promoter methylation status, suggesting that molecular profiles of glioblastoma should be considered when selecting candidates for SRS. SRS prescription dose > 15 Gy and treatment volume ≤ 5 cm3 were associated with longer survival, independent of age and IDH status. Prior gross-total resection and smaller treatment volume were associated with superior local control.

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Transverse sacralization of lumbar vertebrae: prevalence according to Castellvi classification

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164835 ◽

2016 ◽

Vol 3 (1) ◽

pp. 116

Author(s):

Juhi V. Patel ◽

Chetan M. Mehta ◽

Nandakishore G. Patil ◽

Shreya R. Sehgal

Keyword(s):

Lumbar Vertebrae ◽

Lumbar Vertebra ◽

Transverse Process ◽

The Body ◽

Type I ◽

Transitional Vertebra ◽

Spinal Movement ◽

Vertebral Disc ◽

Fifth Lumbar Vertebra ◽

Lumbosacral Transitional Vertebra

Background: Sacralization of L5 is a congenital anomaly, in which the lumbar vertebra, mainly its transverse process, gets fused or semi-fused with the sacrum or the ilium or to both. This fusion can occur in one or both sides of the body. Sacralization leads to fusion of the L5 (fifth lumbar vertebra) and S1 (first sacral vertebra) and the inter-vertebral disc between them may be narrow. Sacralization of lumbar vertebra may be asymptomatic but is not always clinically insignificant. While sacralization may not affect at all, it can cause problems in some cases. Sacralization may be at times associated with problems in biomechanics and affect the ways of movement and posture control. Sacralization may also be an important consideration in disc surgeries. This study has been carried out to find out prevalence of sacralisation of transverse process of fifth lumbar vertebrae.Methods: The present study of transverse sacralisation of fifth lumbar vertebra was carried out on 35 randomly selected patients. The sample consisted of patients undergoing CT scan for abdominal complains. Bone window of all patients were evaluated to look for lumbosacral transitional vertebra.Results: The prevalence of transverse sacralization of lumbar vertebra turned out to be 25.7% out of which Castellvi type IIb was found to be most common, accounting for 33.3% cases. 5.7% comprised the group of normal variant (Castellvi’s type I) and 68.6% were normal. Conclusions: It is important to determine lumbosacral transitional vertebra as it can affect spinal movement and put excess stress on the lumbar vertebrae and in between disc. Moreover it can have a bearing on counting of vertebral levels specially during planning of spinal surgey.

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Biometrical sexual differentiation of fourth, fifth and sixth lumbar vertebrae in blue bull (Boselaphus tragocamelus)

Indian Journal of Animal Research ◽

10.18805/ijar.b-3598 ◽

2018 ◽

Author(s):

S. Sathapathy ◽

B.S. Dhote ◽

D. Mahanta ◽

S. Tamilselvan ◽

M. Mrigesh ◽

...

Keyword(s):

Average Length ◽

Lumbar Vertebrae ◽

Lumbar Vertebra ◽

Transverse Process ◽

Transverse Diameter ◽

Average Height ◽

Legal Cases ◽

Vertebral Canal ◽

Fifth Lumbar Vertebra ◽

Wild Life

The present study was carried out on the lumbar vertebrae of adult Blue bull (Boselaphus tragocamelus) of either sex. Biometrical observations on different parameters of lumbar vertebrae reflected significance (P Less than 0.05) differences between the sexes of this species. It was confirmed that the average length of body gradually decreased from fourth to sixth lumbar vertebrae in the Blue bull. The average transverse diameter or width of vertebral canal and average vertical diameter or height of the vertebral canal was largest in the sixth lumbar vertebra. The average length of transverse process gradually increased from fourth to fifth lumbar vertebra and then it suddenly decreased in the sixth lumbar vertebra. The average height of the dorsal supraspinous process gradually decreased from fourth to sixth lumbar vertebrae and it was lowest in the sixth one. The data on the biometry of fourth, fifth and sixth lumbar vertebrae of Blue bull would develop a baseline that could be useful to the wild life Veterinarians in identification and solving vetero-legal cases.

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Capturing Three-Dimensional In Vivo Lumbar Intervertebral Joint Kinematics Using Dynamic Stereo-X-Ray Imaging

Journal of Biomechanical Engineering ◽

10.1115/1.4025793 ◽

2013 ◽

Vol 136 (1) ◽

Cited By ~ 29

Author(s):

Ameet K. Aiyangar ◽

Liying Zheng ◽

Scott Tashman ◽

William J. Anderst ◽

Xudong Zhang

Keyword(s):

Lumbar Spine ◽

Three Dimensional ◽

Lumbar Vertebrae ◽

Lumbar Vertebra ◽

Weight Lifting ◽

Data Set ◽

X Ray ◽

Biomechanical Models ◽

Lifting Task

Availability of accurate three-dimensional (3D) kinematics of lumbar vertebrae is necessary to understand normal and pathological biomechanics of the lumbar spine. Due to the technical challenges of imaging the lumbar spine motion in vivo, it has been difficult to obtain comprehensive, 3D lumbar kinematics during dynamic functional tasks. The present study demonstrates a recently developed technique to acquire true 3D lumbar vertebral kinematics, in vivo, during a functional load-lifting task. The technique uses a high-speed dynamic stereo-radiography (DSX) system coupled with a volumetric model-based bone tracking procedure. Eight asymptomatic male participants performed weight-lifting tasks, while dynamic X-ray images of their lumbar spines were acquired at 30 fps. A custom-designed radiation attenuator reduced the radiation white-out effect and enhanced the image quality. High resolution CT scans of participants' lumbar spines were obtained to create 3D bone models, which were used to track the X-ray images via a volumetric bone tracking procedure. Continuous 3D intervertebral kinematics from the second lumbar vertebra (L2) to the sacrum (S1) were derived. Results revealed motions occurring simultaneously in all the segments. Differences in contributions to overall lumbar motion from individual segments, particularly L2–L3, L3–L4, and L4–L5, were not statistically significant. However, a reduced contribution from the L5–S1 segment was observed. Segmental extension was nominally linear in the middle range (20%–80%) of motion during the lifting task, but exhibited nonlinear behavior at the beginning and end of the motion. L5–S1 extension exhibited the greatest nonlinearity and variability across participants. Substantial AP translations occurred in all segments (5.0 ± 0.3 mm) and exhibited more scatter and deviation from a nominally linear path compared to segmental extension. Maximum out-of-plane rotations (<1.91 deg) and translations (<0.94 mm) were small compared to the dominant motion in the sagittal plane. The demonstrated success in capturing continuous 3D in vivo lumbar intervertebral kinematics during functional tasks affords the possibility to create a baseline data set for evaluating the lumbar spinal function. The technique can be used to address the gaps in knowledge of lumbar kinematics, to improve the accuracy of the kinematic input into biomechanical models, and to support development of new disk replacement designs more closely replicating the natural lumbar biomechanics.

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