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.

Hypertrophy of the ligamentum flavum in lumbar spinal canal stenosis is associated with abnormal accumulation of specific lipids

Ligamentum flavum hypertrophy (HLF) is the most important component of lumbar spinal canal stenosis (LSCS). Analysis of hypertrophied ligamentum flavum (HLF) samples from patients with LSCS can be an important que. The current study analyzed the surgical samples of HLF samples in patients with LCSC using quantitative and qualitative high performance-liquid chromatography and mass spectrometry. We collected ligamentum flavum (LF) tissue from twelve patients with LSCS and from four patients with lumbar disk herniation (LDH). We defined LF from LSCS patients as HLF and that from LDH patients as non-hypertrophied ligamentum flavum (NHLF). Total lipids were extracted from the LF samples and evaluated for quantity and quality using liquid chromatography and mass spectrometry. The total lipid amount of the HLF group was 3.6 times higher than that of the NHLF group. Phosphatidylcholines (PCs), ceramides (Cers), O-acyl-ω-hydroxy fatty acids (OAHFAs), and triglycerides (TGs) in the HLF group were more than 32 times higher than those of the NHLF group. PC(26:0)+H+, PC(25:0)+H+, and PC(23:0)+H+ increased in all patients in the HLF group compared to the NHLF group. The thickness of the LF correlated significantly with PC(26:0)+H+ in HLF. We identified the enriched specific PCs, Cers, OAHFAs, and TGs in HLF.

ELECTRODIAGNOSTIC PARAMETERS OF TIBIAL & SURAL NERVE IN LUMBAR SPINAL CANAL STENOSIS.

Background: Lumbar spinal canal stenosis (LSCS) is dened as the narrowing of the lumbar spinal canal due to bulging intervertebral discs and/or hypertrophy of the ligamentum avum and facet joints that results in the compression of nerve root that might affect the nerve conduction studies. Objective: To determine the electrodiagnostic parameters of tibial and sural nerve with and severity of lumbar spinal canal stenosis. Methods: A comparative study was conducted on 51 patients of LSCS diagnosed clinically and canal diameter measured on MRI. All patients were subjected to nerve conduction study by EMG Octopus manufactured by Clarity Medical Pvt. Ltd. Results: The mean age of participants was 49.0±16.77 years ( 22-85 years), out of which 26 (50.98%) were males and 25 (49.02%) were females. They were divided into 3 groups based on antero-posterior lumbar canal diameter for severity of stenosis. LSCS was found at multiple levels in spinal cord with most common site is LSCS in L4-L5. There was a signicant decrease in motor nerve conduction (p=0.01(Rt. & Lt. tibial)) and sensory nerve conduction (p= 0.007(Rt. sural), 0.008 (Lt. sural)) velocities. However, signicant differences in motor and sensory latencies and amplitude were not observed. Conclusion: The signicantly reduced motor and sensory nerve conduction velocities are suggestive of functional impairement of the tibial and sural nerve with the severity of LSC; however, the non signicant changes in latencies and amplitude suggests no evidence of peripheral demyelination or axonal loss.

Hypertrophy of the Ligamentum Flavum in Lumbar Spinal Canal Stenosis is Associated with Abnormal Accumulation of Specific Lipids

Purpose. Ligamentum flavum hypertrophy (HLF) is the most important component of lumbar spinal canal stenosis (LSCS). Analysis of hypertrophied ligamentum flavum (HLF) samples from patients with LSCS can be an important que. The current study analyzed the surgical samples of HLF samples in patients with LCSC using quantitative and qualitative high performance-liquid chromatography and mass spectrometry.Methods. We collected ligamentum flavum (LF) tissue from twelve patients with LSCS and from four patients with lumbar disk herniation (LDH). We defined LF from LSCS patients as HLF and that from LDH patients as non-hypertrophied ligamentum flavum (NHLF). Total lipids were extracted from the LF samples and evaluated for quantity and quality using liquid chromatography and mass spectrometry.Results. The total lipid amount of the HLF group was 3.6 times higher than that of the NHLF group. Phosphatidylcholines (PCs), ceramides (Cers), O-acyl-ω-hydroxy fatty acids (OAHFAs), and triglycerides (TGs) in the HLF group were more than 32 times higher than those of the NHLF group. PC(26:0)+H+, PC(25:0)+H+, and PC(23:0)+H+ increased in all patients in the HLF group compared to the NHLF group. The thickness of the LF correlated significantly with PC(26:0)+H+ in HLF. Conclusion. We identified the enriched specific PCs, Cers, OAHFAs, and TGs in HLF.

Influence of Lumbar Spinal Canal Dimensions on Neurological Claudication Symptomatology - A Case Control Study

Lumbar spinal stenosis (LSS) is abnormal narrowing of spinal canal of lumbar vertebrae causing compression of neural tissue which leads to a neurologic deficit. LSS is diagnosed based on clinical symptoms of patient and it is confirmed using MRI (Magnetic Resonance Imaging). The aim of the study is to determine the association between MRI lumbar spinal canal and foraminal dimensions in on neurological claudication symptomology. A total of 89 patients (45 males ,44 females, age range: 20-60 years) referred for MRI Lumbar spine were included in this prospective study. Patients were categorized into symptomatic (49 cases) and asymptomatic (40 controls) based on Edinburgh claudication questionnaire (ECQ). The Antero-posterior diameter of dural sac, Transverse diameter of dural sac, Cross sectional area of dural sac, Cross sectional area of lateral recess, Lateral recess depth, Angle of lateral recess, Ligamentous interfacet distance was measured from L3 to S1 on Axial T2 weighted MRI images. The strength of association between MRI measurements and clinical symptoms were assessed using logistic regression analysis and Cramer’s V test. The Phi coefficient value for the lumbar spinal canal, foraminal dimensions with neurogenic claudication symptomology based on ECQ was 0.108 & 0.207 respectively, which showed weak positive correlation. Our study concludes that MRI measurements of lumbar spinal canal and foraminal dimensions denoting LSS were found to show weak positive correlation with clinical symptoms assessed based on Edinburgh claudication questionnaire.

The impact of sagittal imbalance on walking in patients with lumbar spinal canal stenosis

Purpose: Gait and posture disorder severely impedes the quality of life of affected patients with lumbar spinal canal stenosis (LSCS). Despite the major health concern, there is a paucity of literature about the relationships among spatiotemporal gait parameters and spinal sagittal parameters. This is a cross sectional study performed in a single tertiary referral center to determine the relationships among spatiotemporal gait parameters and spinal sagittal parameters in patients with LSCS. Methods: A total of 164 consecutive patients with LSCS, 87 men and 77 women with mean age of 70.7 years, were enrolled. Spatiotemporal gait parameters were studied using a gait analysis system. Spinal sagittal parameters were studied including sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic inclination (PI), and pelvic tilt (PT) both in the neutral and stepped positions. Results: SVA was significantly larger in the stepped position than in the neutral position (neutral position, 72.5 mm; stepped position, 96.8 mm; p = 0.003). Parameters regarding the pelvis exhibited significant differences, which could represent pelvic anteversion in the stepped position. By stepwise multiple regression analysis, the prediction models, containing SVA (neutral) and PT (stepped) for double supporting phase, exhibited statistical significance, and accounted for approximately 50% of the variance. Conclusions: The present study provides statistically established evidence of correlation among spatiotemporal gait parameters and spinal sagittal parameters. Differences between sagittal parameters in neutral and stepped position may stand for the postural control during gait cycle, and increased SVA in neutral position and increased PT in stepped position may correlate with prolonged double supporting phase.

STUDY THE FIBROSIS AND HYPERTROPHY OF LIGAMENTUM FLAVUM IN LUMBAR SPINAL CANAL STENOSIS DUE TO LEPTIN INDUCED INFLAMMATIO

Lumbar spinal stenosis (LSS) is defined as the narrowing of the spinal canal with cord or nerve root impingement and as consequences the symptoms of radiculopathy or pseudoclaudication are developed. Hypertrophy of the ligamentum flavum (LF) is often involved in the pathogenesis of LSS, resulting in the reduction of diameter of the spinal canal and compression of the dural sac and nerve roots.Leptin's important role in various biological functions further than appetite regulation and energy metabolism.Interestingly collective evidence suggests it has a critical role in the fibrosis process in multiple organ systems, including the liver, kidney, and lung. The aim of this study was to establish a relationship between serum leptin levels and the fibrosis and hypertrophy of ligamentum flavum in lumbar spinal canal stenosis. METHOD: Our study include 100 patient with ligamentum flavum hypertrophy with lumbar canal stenosis to evaluate co-relation with increased serum leptin levels. Demographic data, clinical, radiological and laboratory investigation done to find a co-relation between increased serum leptins levels with the fibrosis and hypertrophy of ligamentum flavum in lumbar canal stenosis.RESULT:In our study,LF thickness was also measured with a T1weighted axial MRI.The mean thickness in the high vas scores (> 5) group was signicantly thicker than that in the low vas (< 5) group. Serum leptin values were positively correlated to LF Thickness at L4-L5 (r=0.228) and L5-S1 (r=0.198) level and the correlation was significant (p>0.05). CONCLUSION: Our study has shown strong correlation between serum levels of leptin and hypertrophy of ligamentum flavum.VAS score in low VAS group (< 5) as well as high VAS score group (> 5) are positively correlated with serum levels of leptin