Background:
Metastatic spinal cord compression with carcinoid tumor as primary is a rare entity with its own diagnostic dilemmas and surgical challenges. Most of these neuroendocrine tumors arise ...from the gastrointestinal tract or lungs with metastasis to spine in <2% cases. Early diagnosis in an orderly manner is of significance as most of it is delayed due to slowly developing symptoms. Furthermore, prompt management has been an important factor as morbidity and mortality are high in such cases and surgical intervention if needed, which can be a challenge due to disturbed alignment, complex regional anatomy, and careful handling of spinal cord.
Case Description:
The authors describe a case report on similar lines of a middle aged gentleman presenting with low back pain and weakness in both lower limbs which on further investigations revealed a pathological fracture causing spinal cord compression due to metastasis from small cell carcinoma in the lungs, managed with surgical intervention, and subsequently with radiotherapy.
Conclusion:
Secondary metastatic deposits in the lumbar vertebrae due to carcinoid tumors in the lungs are a rare entity and can be difficult to diagnose and manage further. However, it should be included in the list of differential diagnosis. The case report emphasizes on using investigative modalities such as PET-CT scan to aid an early diagnosis and plan further treatment plan as early as possible to offer a better quality of life to the patients.
Abstract Background Endoscopic spine lumbar interbody fusion (Endo-LIF) is well-regarded within the academic community. However, it presents challenges such as intraoperative disorientation, high ...rates of nerve damage, a steep learning curve, and prolonged surgical times, often occurring during the creation of the operative channel. Furthermore, the undefined safe operational zones under endoscopy continue to pose risks to surgical safety. We aimed to analyse the anatomical data of Kambin’s triangle via CT imaging to define the parameters of the safe operating area for transforaminal posterior lumbar interbody fusion (TPLIF), providing crucial insights for clinical practice. Methods We selected the L4–L5 intervertebral space. Using three-dimensional (3D), we identified Kambin’s triangle and the endocircle within it, and recorded the position of point ‘J’ on the adjacent facet joint as the centre ‘O’ of the circle shifts by angle ‘β.’ The diameter of the inscribed circle ‘d,’ the abduction angle ‘β,’ and the distances ‘L1’ and ‘L2’ were measured from the trephine’s edge to the exiting and traversing nerve roots, respectively. Results Using a trephine with a diameter of 8 mm in TPLIF has a significant safety distance. The safe operating area under the TPLIF microscope was also clarified. Conclusions Through CT imaging research, combined with 3D simulation, we identified the anatomical data of the L4–L5 segment Kambin’s triangle, to clarify the safe operation area under TPLIF. We propose a simple and easy positioning method and provide a novel surgical technique to establish working channels faster and reduce nerve damage rates. At the same time, according to this method, the Kambin’s triangle anatomical data of the patient’s lumbar spine diseased segments can be measured through CT 3D reconstruction of the lumbar spine, and individualised preoperative design can be conducted to select the appropriate specifications of visible trephine and supporting tools. This may effectively reduce the learning curve, shorten the time operation time, and improve surgical safety.
A scoping review.
We aimed to identify and characterize grading systems of the inflammatory features of the lumbar facet joints (FJs) noted on magnetic resonance imaging and summarize their ...reliability.
Chronic low back pain is one of the most common causes of disability worldwide and is frequently accompanied by FJ osteoarthritis. Inflammatory changes in the lumbar FJs are commonly noted in imaging studies of patients with FJ osteoarthritis and low back pain. Several grading systems for these inflammatory changes have been developed. However, these grading system's features and reliability have yet to be reviewed.
We performed a literature search of studies reporting grading systems for FJ inflammatory changes published in English or Spanish between 1985 and 2022. We collected data on reported interreader reliability measures of each grading system. Finally, we compared the features of inflammation described by each system.
Six studies met the inclusion criteria and were used in our analysis. Features commonly graded in these systems are the hyperintensity signal noted within the FJ, bone marrow edema, and the extent of the soft-tissue edema surrounding the FJs. We found that the interreader reliability measures ranged from 0.56 to 0.96.
Only 6 studies have reported methods for documenting inflammation in the FJs. Studies varied in the precise tissues and phenomena included in the grading systems. However, the systems were generally reliable. Future studies should document the reliability of these methods when independent investigators are not involved in developing the classification schemes. Further work might combine one or more of these measures to establish a standard and reliable grading system for inflammatory changes in the FJs, including signal intensity within the joint, bone marrow edema, and soft-tissue inflammation.
Background:
Recently, lumbopelvic control has been linked to pitching performance, kinematics, and loading; however, poor lumbopelvic control has not been prospectively investigated as a risk factor ...for injuries in baseball pitchers.
Hypothesis:
Pitchers with poor lumbopelvic control during spring training are more likely to miss ≥30 days because of an injury through an entire baseball season than pitchers with good lumbopelvic control.
Study Design:
Cohort study; Level of evidence, 2.
Methods:
A total of 347 professional baseball pitchers were enrolled into the study during the last 2 weeks of spring training and stayed with the same team for the entire season. Lumbopelvic control was quantified by peak anterior-posterior deviation of the pelvis relative to the starting position during a single-leg raise test (APScore). Days missed because of an injury through the entire season were recorded by each team’s medical staff.
Results:
A higher APScore was significantly associated with a higher likelihood of missing ≥30 days (P = .023, χ2 test). When divided into tertiles based on their APScore, participants in the highest tertile were 3.0 times and 2.2 times more likely to miss at least 30 days throughout the course of a baseball season relative to those in the lowest or middle tertiles, respectively. A higher APScore was also significantly associated with missing more days because of an injury within participants who missed at least 1 day (P = .018, ANOVA), with participants in the highest tertile missing significantly more days (mean, 98.6 days) than those in the middle tertile (mean, 45.8 days; P = .017) or lowest tertile (mean, 43.8 days; P = .017).
Conclusion:
This study found that poor lumbopelvic control in professional pitchers was associated with an increased risk of missing significant time because of an injury.
Background:
Lumbar bone stress injury (BSI) is a high-risk long time—loss injury for adolescent soccer players. However, the risk factors for lumbar BSI are unclear.
Purpose:
To identify the risk ...factors for bilateral lumbar BSI for adolescent soccer players.
Study Design:
Case-control study; Level of evidence, 3.
Methods:
Adolescent soccer players underwent orthopaedic examination, whole-body dual energy x-ray scan, lumbar magnetic resonance imaging (MRI), and muscle tightness testing at baseline. Lumbar lordosis (LL), sacral slope, maturity stage of lumbar vertebral body, and bone marrow edema (BME) at the L5 were examined via MRI. In addition, bone mineral density and content; trunk lean body mass via dual energy x-ray scan; and bilateral muscle tightness including the iliopsoas, hamstrings, and quadriceps were measured. Lumbar BSI was diagnosed as positive bilateral BME and extension-based lumbar pain. All participants were examined twice, one at 6 months and one at 1 year, after the baseline examination. Multivariate logistic regression analysis was performed to identify the risk factors for bilateral lumbar BSI.
Results:
A total of 69 (26.3%) players were diagnosed with bilateral lumbar BSI. Asymptomatic BME (odds ratio OR, 4.260; 95% CI, 2.153-8.431), apophyseal stage of the lumbar vertebral body (OR, 3.438; 95% CI, 1.698-6.959), sacral slope relative to LL ≥5° (OR, 4.067; 95% CI, 2.021-8.181), and hamstring tightness ≥50° (OR, 3.221; 95% CI, 1.385-7.489) were significantly associated with bilateral lumbar BSI.
Conclusion:
The incidence of bilateral lumbar BSI was common at 26.2%. Asymptomatic BME, sacral anterior tilt relative to LL, immature lumbar epiphyses, and hamstring tightness were found to be risk factors for bilateral lumbar BSI. The results of this study suggest that regular MRI examination could facilitate the early detection of BME, and improvement in hamstring flexibility and lumbosacral alignment may prevent bilateral lumbar BSI in young athletes.
Background
In patients with congenital adrenal hyperplasia (CAH) type and doses of glucocorticoids used as well as sex hormone secretion during puberty have important actions on bone mineral density ...(BMD) in adulthood.
Aim
To evaluate BMD in adult CAH patients depending on current glucocorticoid therapy and on androgen levels in adulthood and at age 16 years.
Methods
We included 244 CAH patients from the dsd‐LIFE cohort (women n = 147, men n = 97; salt‐wasting n = 148, simple‐virilizing n = 71, nonclassical n = 25) in which BMD and bloods were available. Clinical and hormonal data at age 16years were retrieved from patients' files.
Results
Simple‐virilizing women showed lower BMD compared to salt‐wasting women at trochanter (0.65 ± 0.12 vs 0.75 ± 0.15 g/cm2; P < .050), whole femur T‐score (−0.87 ± 1.08 vs −0.16 ± 1.24; P < .05) and lumbar T‐score (−0.81 ± 1.34 vs 0.09 ± 1.3; P < .050). Fracture prevalence did not differ significantly between the CAH groups. Prednisolone vs. hydrocortisone only therapy caused worse trochanter Z‐score (−1.38 ± 1.46 vs −0.47 ± 1.16; P < .050). In women lumbar spine, BMD correlated negatively with hydrocortisone‐equivalent dose per body surface (r2 = 0.695, P < .001). Furthermore, BMI at age 16years correlated positively with lumbar spine T‐score (r2 = 0.439, P = .003) and BMD (r2 = 0.420, P = .002) in women. The androstenedione/testosterone ratio at age 16years correlated positively with lumbar spine Z‐score in women (r2 = 0.284, P = .024) and trochanter Z‐score in men (r2 = 0.600, P = .025).
Conclusion
Higher glucocorticoid doses seemed to cause lower BMD especially in women. Prednisolone appeared to have more detrimental effects on BMD than hydrocortisone. Higher glucocorticoid doses (lower androstenedione/testosterone ratio) during adolescence may cause lower BMD in adulthood.
Robot-guided lumbar spine surgery has evolved rapidly with evidence to support its utility and feasibility compared with conventional freehand and fluoroscopy-based techniques. The objective of this ...study was to assess trends among the top 25 most-cited articles pertaining to robotic-guided lumbar spine surgery.
An "advanced document search" using Boolean search operator terms was performed on 16 November 2022 through the Web of Science and SCOPUS citation databases to determine the top 25 most-referenced articles on robotic lumbar spine surgery. The articles were compiled into a directory and hierarchically organized based on the total number of citations.
Cumulatively, the "Top 25" list for robot-assisted navigation in lumbar spine surgery received 2240 citations, averaging 97.39 citations annually. The number of citations ranged from 221 to 40 for the 25 most-cited articles. The most-cited study, by Kantelhardt et al, received 221 citations, averaging 18 citations per year.
As utilization of robot-guided modalities in lumbar spine surgery increases, this review highlights the most impactful studies to support its efficacy and implementation. Practical considerations such as cost-effectiveness, however, need to be better defined through further longitudinal studies that evaluate patient-reported outcomes and cost-utility.
Through an overview of the top 25 most-cited articles, the present review highlights the rising prominence and technical efficacy of robotic-guided systems within lumbar spine surgery, with consideration to pragmatic limitations and need for additional data to facilitate cost-effective applications.
An autopsy study.
To investigate associations between various types of lumbar endplate lesions, disc degeneration (DD), and back pain history.
The well-innervated vertebral endplate has been ...suspected as a source of back pain. Previously, we observed 4 types of lumbar endplate lesions with distinct morphological characteristics. Their roles in DD and back pain remain unclear.
From a lumbar spine archive of 136 men (mean age, 52 yr), back pain, back injury, and occupation history data for 69 subjects and discography data for 443 discs from 109 subjects were available for study. Back pain history was categorized as none, occasional, or frequent. DD was judged from discography. Endplate lesions were classified as Schmorl's nodes, fracture, erosion, or calcification, and lesion size was rated as none, small, moderate, or large. Associations between endplate lesions and DD, back pain history, back injury, and occupation history were examined.
Presence of endplate lesions was associated with frequent (odds ratio OR = 2.57) but not occasional back pain. However, large endplate lesions were associated with both occasional (OR = 8.68) and frequent (OR = 17.88) back pain. This association remained after further controlling for DD. Also, the presence of each type of endplate lesion was associated with adjacent DD (OR = 2.40-9.71), with larger lesions associated with more severe DD. Endplate erosion lesions were more strongly associated with adjacent DD than Schmorl's nodes. Although back injury history was associated with the presence of fracture and erosion lesions, heavy occupation was associated with the presence of Schmorl's nodes.
Endplate lesions are associated with back pain as well as being closely associated with adjacent DD, with a clear dosage effect. Different types of endplate lesions seem to have different magnitudes of associations with DD. Lumbar endplate lesions may be an important key to better understand both DD and back pain.
This study aimed to evaluate the effect of perioperative transcutaneous electrical acupoint stimulation (TEAS) on postoperative cognitive dysfunction (POCD) in older patients with lumbar spine ...surgery.
Older patients (aged 60-80 years old) receiving lumbar spine surgery under general anesthesia were randomly divided into group A, 3-day intervention group; group B, 7-day intervention group; control group C, sham TEAS group, selected "Baihui" (GV 20) and "Dazhui" (GV 14) point was intervened once 30 min before operation with "HANS" transcutaneous electrical stimulation device, and then once a day after operation for 30 min each time. The primary outcome was the incidence of postoperative cognitive impairment assessed by the use of the Mini Mental Rating Scale (MMSE), patients developed POCD according to the Z score method. The secondary outcome was serum interleukin-6 (IL-6), tumor Necrosis factor α (TNF-α), neuron-specific enolase (NSE), and S100β protein levels.
Three days after surgery, the incidence of POCD in groups A((22.4%)) and B ((18.3%)) were lower than those in group C ((42.9%)) (
< 0.05). There was no significant difference between groups A and B (
> 0.05). Seven days after surgery, the incidence of POCD in group B (18.3%) was lower than that in groups A (26.5%) and B (42.9%), and the comparison between groups B and C was statistically significant (
< 0.05). On the 3rd and 7th days after surgery, the levels of IL-6, TNF-α, NSE, and S100β in the two TEAS groups were lower than those in the sham TEAS group (
< 0.01), but higher than the preoperative levels in the three groups (
< 0.01).
It seems that Perioperative TEAS intervention could reduce the level of inflammatory factors IL-6, TNF-α in the blood of older patients with lumbar spine surgery, and reduce the incidence of POCD.
www.chictr.org.cn, identifier ChiCTR2200063030.
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