Study of pedicles and spinal canal diameters at the level of lumbar vertebral in normal adult Saudi population using computed tomography

The values of normal transverse (interpedicular) and sagittal (midsagittal) diameters are different at various levels of lumbar spinal canal in individuals of the same race and differ at identical levels in individuals of various races. The aim of the study was to determine normal reference range of the lumbar spinal canal dimensions and to evaluate lumbar pedicle dimensions with respect to spinal level, age, gender in Saudi population by using Computed Tomography. This study was conducted in Najran province (K.S.A), archival abdominal CT scan images from PACS in hospitals were used. The data of this study was collected from 210 (102 male and 108 female) normal Saudi adults individuals with different ages, gender over a period of 20 months (2019 - 2021). The mean spinal canal transverse distance (SCTR) showed steady decrease from L1 to L4, as there was an increasing in (SCTR) at L5 relative to L4, The mean spinal canal anteroposterior diameter (SCAP) showed a decrease from L1 to L3, and then a gradual increase from L4 to L5 (Fig.4-10). This pattern was observed in males only as there was an increase of female (SCAP) at L2 and L5, and no significant gender difference was noted at any lumbar level for (SCAP) The mean pedicle width (PW) showed steady increase from L1 to L5. While the mean pedicle height (PH) showed a gradual decrease from L1 to L5. The study conclude that Computed tomography is a reliable method for determining the morphological measurements of the spinal canal and pedicles diameter.

The effects of vertebral body tethering on sagittal parameters: evaluations from a 2-years follow-up

Introduction While the effects of VBT on coronal parameters have been investigated in various studies, this has not yet been the case for sagittal parameters. This is of particular relevance considering that VBT does not allow direct correction of the sagittal profile. Thus, we investigated the effects of VBT on sagittal parameters in patients with adolescent idiopathic scoliosis. Materials and methods Retrospective, 2-Center study. Patients who underwent VBT and presented a 2-years follow-up were included. The differences in sagittal parameters were evaluated, along with modifications of sagittal profile following Abelin-Genevois’ classification. Results Data from 86 patients were obtained. Mean Cobb angle was 52.4 ± 13.9° at thoracic level and 47.6 ± 14.3° at lumbar level before surgery, and 28.5 ± 13.6 and 26.6 ± 12.7° at the 2-year follow-up, respectively. Mean thoracic kyphosis increased from 28.3 ± 13.8 to 33 ± 13°, the lumbar lordosis (LL) was unvaried (from 47.5 ± 13.1 to 48.4 ± 13.5°), PT decreased from 9.4 ± 8.5 to 7.4 ± 6.1°, the sagittal vertical axis SVA decreased from 4.5 ± 31.4 to − 3.6 ± 27.9 mm. No kyphotic effect on LL in patients who underwent lumbar instrumentation was observed. Before surgery, 39 patients had a type 1 sagittal profile, 18 were type 2a, 14 type 2b and 15 type 3. Postoperatively, 54 were type 1, 8 were 2a, 13 were 2b and 11 were type 3. Conclusions VBT positively influences sagittal parameters and does not have a kyphotic effect on LL.

The corticospinal tract primarily modulates sensory inputs in the mouse lumbar cord

It is generally assumed that the main function of the corticospinal tract (CST) is to convey motor commands to bulbar or spinal motoneurons. Yet the CST has also been shown to modulate sensory signals at their entry point in the spinal cord through primary afferent depolarization (PAD). By sequentially investigating different routes of corticofugal pathways through electrophysiological recordings and an intersectional viral strategy, we here demonstrate that motor and sensory modulation commands in mice belong to segregated paths within the CST. Sensory modulation is executed exclusively by the CST via a population of lumbar interneurons located in the deep dorsal horn. In contrast, the cortex conveys the motor command via a relay in the upper spinal cord or supraspinal motor centers. At lumbar level, the main role of the CST is thus the modulation of sensory inputs, which is an essential component of the selective tuning of sensory feedback used to ensure well-coordinated and skilled movement.

Increased Asymmetry of Trunk, Pelvis, and Hip Motion during Gait in Ambulatory Children with Spina Bifida

Spina bifida (SB) is caused by incomplete neural tube closure and results in multiple impairments, including muscle weakness. The severity of muscle weakness depends on the neurologic lesion level. Though typically symmetric, there can be asymmetries in neurologic lesion level, motor strength, skeletal structures, and body composition that affect patients’ gait and function. Using body segment and joint motion obtained through 3D computerized motion analysis, we evaluated asymmetry and range of motion at the hip, pelvis, and trunk in the frontal and transverse planes during gait in 57 ambulatory children with SB and 48 typically developing controls. Asymmetry and range of hip, pelvis, and trunk motion in the frontal and transverse planes were significantly greater for patients with mid-lumbar and higher level lesions compared with those having sacral/low-lumbar level lesions and controls without disability (p ≤ 0.01). Crutch use decreased asymmetry of trunk rotation in mid-lumbar level patients from 10.5° to 2.6° (p ≤ 0.01). Patients with asymmetric involvement (sacral level on one side and L3-4 on the other) functioned similarly to sacral level patients, suggesting that they may be better categorized using their stronger side rather than their weaker side as is traditional. The information gained from this study may be useful to clinicians when assessing bracing and assistive device needs for patients with asymmetric SB involvement.

Occurrence of Volcanogenic Inorganic Mercury in Wild Mice Spinal Cord: Potential Health Implications

Mercury accumulation has been proposed as a toxic factor that causes neurodegenerative diseases. However, the hazardous health effects of gaseous elemental mercury exposure on the spinal cord in volcanic areas have not been reported previously in the literature. To evaluate the presence of volcanogenic inorganic mercury in the spinal cord, a study was carried out in São Miguel island (Azores, Portugal) by comparing the spinal cord of mice exposed chronically to an active volcanic environment (Furnas village) with individuals not exposed (Rabo de Peixe village), through the autometallographic silver enhancement histochemical method. Moreover, a morphometric and quantification analysis of the axons was carried out. Results exhibited mercury deposits at the lumbar level of the spinal cord in the specimens captured at the site with volcanic activity (Furnas village). A decrease in axon calibre and axonal atrophy was also observed in these specimens. Given that these are relevant hallmarks in the neurodegenerative pathologies, our results highlight the importance of the surveillance of the health of populations chronically exposed to active volcanic environments.

Lumbar Level Significantly Influences Postoperative Global Sagittal Balance Following Pedicle Subtraction Osteotomy

Study Design: Retrospective cohort study. Objectives: The current evidence regarding how level of lumbar pedicle subtraction osteotomy (PSO) influences correction of sagittal alignment is limited. This study sought to investigate the relationship of lumbar level and segmental angular change (SAC) of PSO with the magnitude of global sagittal alignment correction. Methods: This study retrospectively evaluated 53 consecutive patients with adult spinal deformity who underwent lumbar PSO at a single institution. Radiographs were evaluated to quantify the effect of PSO on lumbar lordosis (LL), thoracic kyphosis (TK), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), T1-spinopelvic inclination (T1SPI), T1-pelvic alignment (TPA), and sagittal vertical axis (SVA). Results: Significant correlations were found between PSO SAC and the postoperative increase in LL ( r = 0.316, P = .021) and PT ( r = 0.352, P = .010), and a decrease in TPA ( r = −0.324, P = .018). PSO level significantly correlated with change in T1SPI ( r = −0.305, P = .026) and SVA ( r = −0.406, P = .002), with more caudal PSO corresponding to a greater correction in sagittal balance. On multivariate analysis, more caudal PSO level independently predicted a greater reduction in T1SPI (β = −3.138, P = .009) and SVA (β = −29.030, P = .001), while larger PSO SAC (β = −0.375, P = .045) and a greater number of fusion levels (β = −1.427, P = .036) predicted a greater reduction in TPA. Conclusion: This study identified a gain of approximately 3 degrees and 3 cm of correction for each level of PSO more caudal to L1. Additionally, a larger PSO SAC predicted greater improvement in TPA. While further investigation of these relationships is warranted, these findings may help guide preoperative PSO level selection.

Can I have epidural analgesia if I have tinea versicolor?

Labor and delivery, while perceived as gratifying and joyful, are nonetheless among the most painful events women can experience in life. Treating pain is nowadays one of the essential elements in assisting women during labor. Epidural analgesia is the best option to ensure the optimal control of pain for the mother without compromising the wellbeing of the fetus. The main contraindications to neuraxial analgesia techniques include patient refusal, known bleeding diathesis or abnormal coagulation tests, elevated intracranial pressure (particularly in the presence of an intracranial space occupying lesion), severe aortic or mitralic valve stenosis and infections at the puncture site [1]. There are many pathogens responsible for cutaneous infections at the dorsal-lumbar level, yeasts of the Malassetia genus being the most commonly implicated. Malassetia Globulosa is the predominant species in the Tinea Versicolor infection [2,3]. Also implicated are M. Sympodialis, M. Furfur and others as well [4]. These fungi are normal components of the cutaneous flora but the transformation from yeasts to micelia can lead to the pathology. The cause for this occurrence is still unknown, yet there are a few contributing factors leading to this infection that affects mostly adolescents and young adults; these are genetic predisposition [5], heat and humidity, immunosuppression, contraceptives, pregnancy and malnutrition. It manifests with characteristic hypo- or hyper-pigmented spots alongside the trunk, the neck, and the face. The majority of the times infection is entirely superficial but cases of meningitis and Central Nervous System (CNS) infections from hematogenous spread have been reported [6,7]. The literature supports with data that adequate antiseptic preparation of the skin effectively prevents meningitis occurrence after epidural puncture [8]; other cases are reported where a small incision of the skin allows for a safer passage of the needle directly in the subcutis without going thnrough the corneal layer.

Removal of Intradural Extramedullary Schwannoma at Lumbar Level by Doing Laminoplasty in Paediatric Patient- A Case Report and Review of Literature

Intradural Extramedullary tumour of thoracolumbar spine has been mainly treated with laminectomy till date. Other approach has been of treating this pathology by doing laminoplasty. Objective of this case presentation is that laminoplasty is better option for IDEM in selected cases. Laminectomy has been associated with many complications which can be avoided by doing laminoplasty such as postoperative spinal instability, epidural fibro¬sis, kyphotic deformity, excessive blood loss, hematoma invasion, progressive myelopathy, persistent back pain and prolonged hospital stay. So laminoplasty has clearly advantage compared to laminectomy in preserving posterior arch of the spine. Revision surgery is also easier when primary surgery has been done by laminoplasty. In our case of 13-year-old boy having Intradural Extramedullary Schwannoma at L3 level, he was treated with flipping laminoplasty and tumour excision. At final follow up he was having complete clinical recovery and fully healed laminoplasty assessed with CT scan without any recurrence of tumour or any spinal deformity. It proves our purpose of doing laminoplasty with better outcome compared to laminectomy. Keywords: Laminoplasty; Laminectomy; Intradural Extramedullary; Spinal Cord Tumour.

Mashkov’s diamond as an indicator of posture in boys of the second childhood period at the initial stage of martial arts

Aim: boys of the second childhood period at the initial stage of martial arts to study the age characteristics of Mashkov’s diamond and the depth of the vertebral pole lordosis at the cervical and lumbar level as indicators of posture. Material and methods. 28 boys of the second childhood period (8-12 years) engaged in martial arts on the basis of JUSS No. 3 by V. G. Khromin of Tyumen were examined. The evaluation of Mashkov’s diamond was carried out according to the conventional method. The depth of the vertebral column lordosis at the cervical and lumbar level as an indicator of posture was assessed with the help of the device proposed by us (Russian Patent for useful model No. 30253). Results. The age-old size of Mashkov’s diamond sides increased as the boys grew up and did not indicate scoliotic spinal column disease. The “jumps” of its increase in the period of 11-12 years have been revealed. The age-related increase in the depth of lordosis at the cervical and lumbar level of the spinal column, more pronounced in the lumbar department, has been noted. Conclusion. According to Мashkov’s diamond, boys of the second childhood period have no abnormalities on the part of the spinal column. The depth of the vertebral pole lordosis at the lumbar level exceeds the depth of the cervical lordosis, which should be taken into account when dosing physical activity in physical education classes in the secondary school and during the training process in JUSH.