A rare case of iliopsoas abscess caused by a retained shrapnel from a blast injury

Iliopsoas abscesses (IPA) are uncommon, with an associated mortality rate of up to 20%. We describe the case of a 55-year-old man war veteran who presented with an unusual cause of IPA secondary to retained foreign body (FB). His initial trauma 30 years before was a result of a blast injury with shrapnel penetration suffered after inadvertently driving over a landmine as an ambulance driver in a conflict region. A CT scan was performed, revealing a 13 mmx8 mm radio-opaque FB within the right psoas at the level of the fifth lumbar vertebra with a surrounding collection. Subsequent open surgical exploration removed two gravel fragments. Given the knowledge of a traumatic blast injury with retained FB and repeated episodes of sepsis, surgical exploration is warranted. To our knowledge, this is the first case of recurrent IPA secondary to a retained FB from a historical trauma.

RELATIONSHIP BETWEEN SACRALIZATION AND LOW BACK PAIN IN RURAL POPULATION

Sacralization is an embryo congenital defect in which the fifth lumbar vertebra is fused to the sacrum in various degrees. The prevalence of sacralization is 7.5 percent. Sacralization can be unilateral or bilateral. This disorder arises due to irregularities in the lumbosacral spine segmentation during development. Transverse process of the L5 on one side or both sides is wider than usual and fuses into the sacrum or ilium or both in the sacralization of the fifth lumbar vertebra. Low back pain is the most common symptom in most of the population throughout their lifetime. As low back pain is a leading cause of disability, interfering with quality of life and job outcomes our goal is to assess the association between sacralisation and low back pain. Purpose: To study the relationship between sacralization and low back pain. Because the role of sacralization throughout causing LBP is still controversial. This is the observational study which includes 55 participants who have low back ache. The participants are between the ages 60 to 70 years. The intensity of pain was assessed through NPRS. To assess the relationship between Sacralization and low back pain, all the participants were sent for Xray and the presence of Sacralization was assessed by X-ray. We found that there was a significant relationship between sacralization and low back pain. The patients with sacralization show the high intensity of low back pain. We concluded that Sacralization affects the lumbosacral spine in different ways and result in pain in lower back. And there is significant association of sacralization with low back ache.

Frequency of Sacralisation of Fifth Lumber Vertebra in South Punjab Pakistani Population

Background: Lumbosacral joint carries whole body weight and transmits it to tibia. As the 5th Lumbar Vertebra transits into first Sacral Vertebra, fifth Lumbar Vertebra may be fused on one or both sides to the first Sacral Vertebra, Condition known as ‘Sacralisation’. Aim: To find the frequency of sacralisation of 5th Lumbar Vertebra in South Punjab Pakistani Population. Methods: It was a descriptive observational study conducted in Anatomy Department Quaid-e-Azam Medical College, Bahawalpur. This was descriptive observational study conducted on cadaveric sacra collected in last 7 years. 86 dry Human adult sacra of known sex were observed and results were noted for Sacralisation of Lumbar Vertebra. Results: Out of 86 cadaveric Sacra, Sacralisation was found in 12(14%). Out of these 12, 8 Sacra showed complete Sacralisation while 4 Sacra showed incomplete Sacralisation. Conclusion: Sacralisation of 5th Lumbar Vertebra is common (14%) in cadaveric sacra of South Punjab, Pakistani Population. Key words: Lumbar Vertebra, Sacralisation, Cadaveric, L5 (5th lumbar vertebrae), S1 (1st Sacral Vertebrae).

What is the difference in pedicle morphology of the fifth lumbar vertebra between isthmic and degenerative L5-S1 spondylolisthesis? An anatomic study of 328 patients via multi-slice spiral computed tomography

Purpose The purpose of this study was to investigate and determine whether there are differences in L5 pedicles morphology between isthmic and degenerative L5-S1 spondylolisthesis. Methods One hundred and nineteen patients with isthmic spondylolisthesis and 45 patients with degenerative spondylolisthesis at L5-S1 were enrolled in the IS group and DS group, respectively, and 164 lumbar disc herniation patients without spondylolysis or spondylolisthesis were classified into the normal (NL) group. A series of pedicle parameters of the fifth lumbar vertebra, including pedicle length (PL), pedicle width (PW), pedicle screw trajectory length (PSTL), pedicle height (PH), and the pedicle camber angle (PCA) were measured using multi-slice spiral computed tomography (MSCT). The slip distance of the L5 vertebra was measured on radiography, and the percentage of slip was also recorded. Results The pedicles of the fifth lumbar vertebra were shorter and wider, and the PCA was larger in the IS group compared to the DS group and NL group. On the contrary, the pedicles in the DS group were elongated and thinner, and the PCA was smaller. The pedicle parameters of PL were significantly positively correlated with the percentage of slip in the DS group, but PW and PCA were negatively correlated with the percentage of slip. There was no correlation between the percentage of slip and L5 pedicle parameters in the IS group. Conclusions The L5 pedicles morphology in L5-S1 isthmic spondylolisthesis shows abduction, shortness, and width, while that in the degenerative spondylolisthesis shows adduction, lengthening, and thinning compared with the normal populations. The morphology changes may be the result of pedicle stress remodeling in the development of spondylolisthesis, which should be taken into consideration when placing at the insertion of pedicle screws.

Familial development of lumbar spondylolysis: a familial case report of 7- and 4-year-old brothers and their father

The incidence of lumbar spondylolysis is affected by sex, race, and congenital abnormalities. These differences suggest a genetic component to the etiology of spondylolysis. However, no definitive evidence has been presented regarding the inheritance of lumbar spondylolysis. We report familial cases of lumbar spondylolysis in 7- and 4-year-old brothers and their father, each of whom visited our clinic complaining of low back pain. Spondylolysis in the fifth lumbar vertebra (L5) was identified in both boys and their father from clinical, radiographic, computed tomographic, and magnetic resonance imaging examinations. Conservative treatment was provided for both boys. No bony union of any spondylolytic lesions was obtained, but they returned to sports activity without low back pain. Frequent development of spondylolysis, even at younger ages, in all male family members might indicate an underlying genetic etiology in lumbar spondylolysis, primarily in the form of autosomal dominant inheritance. However, information on patients and their parents should be considered carefully, as bony union with conservative therapy is not expected in such patients.