There is evidence that various anatomical structures have altered morphology with ageing, and anecdotal evidence of changing lumbar
Background: The Lumbar Spinous Processes (LSP) have an important anatomical and biomechanical function. They also influence access to the spinal canal for neural decompressive surgical procedures. There is evidence that various anatomical structures have altered morphology with ageing, and there is anecdotal evidence of changing LSP morphology with age. This study aims to clarify the influence of age on LSP morphology, and on lumbar spine alignment. Method: 200 CT scans of the abdomen were reformatted with bone windows allowing precise measurement of LSP dimensions, and Lumbar Lordosis. Observers were blinded to patient demographics. Inter-observer reliability was confirmed. Results: The smallest LSP is at L5. The male LSP is on average 2–3mm higher and 1mm wider than the female LSP. LSP height increases significantly with age at every level in the lumbar spine (P<
10-5 at L2). The LSPs increase in height by 2–5mm between 20–85 years of age (P<
10-6), which was as much as 31% at L5 (P<
10-8). Width increases proportionally more, by 3–4mm or greater than 50% at each lumbar level (P<
10-11). Lumbar lordosis decreases in relation to increasing LSP height (P<
10-4) but is independent of increasing LSP width (P=0.2). Conclusions: The height and width of the
The study aim was to simulate oblique
The purpose of this study was to establish the relationship between the anterior and posterior spinal elements and identify which morphological changes in the ageing spine has the greatest influence in determining the loss of lumbar lordosis. Method. 224 patients' (98 male, 126 female) erect plain lumbar radiographs were reviewed. Lateral plane projections were used to measure the lumbar angle (lordosis),
Auckland City Hospital, Auckland, New Zealand. To show that the
Introduction:
The Lumbar Spinous Processes (LSP) have an important anatomical and biomechanical function protecting the neural structures in the spinal canal, and as an anchor for the inter and supraspinous ligaments, and the inter-segmental paraspinal muscles. They also influence access to the spinal canal for neural decompressive surgical procedures. More recently the LSPs have attracted increased interest as a site for surgical device attachment in an attempt to both decrease the symptoms of spinal stenosis, and as a site for intersegmental stabilization without formal fusion. There is evidence that various anatomical structures have altered morphology with ageing, and there is anecdotal evidence of changing LSP morphology with age. This study aims to clarify the influence of age on LSP morphology, and on lumbar spine alignment.
200 CT scans of the abdomen were reformatted with bone windows in sagittal and coronal planes allowing precise measurement of LSP dimensions, and Lumbar Lordosis. Observers were blinded to patient demographics. Inter-observer reliability was examined. Data was analysed by an independent statistician.
The smallest LSP is at L5. The male LSP is on average 2–3mm higher and 1mm wider than the female LSP. LSP height increases significantly with age at every level in the lumbar spine (p< 10-5 at L2). The LSPs increase in height by 2–5mm between 20–85 years of age (p< 10-6), which was as much as 31% at L5 (p< 10-8). Width increases proportionally more, by 3–4mm or greater than 50% at each lumbar level (p< 10–11). Lumbar lordosis decreases in relation to increasing LSP height (p< 10-4) but is independent of increasing LSP width (p=0.2).
This study demonstrates that the dimensions of the LSP change with age. Increases in LSP height occur with age. More impressive increases in LSP width occur with advancing age. This study suggests that loss of lumbar lordosis is correlated with changing LSP morphology.
The increased width of the LSP with age influences access to the spinal canal, particularly if midline-preserving approaches are attempted in the ageing population. There is increased bone volume for bone grafting procedures with increasing age. The reduced distance between LSPs with age may influence design of implants that stabilize this region of the spine, and occur not only as a result of disc space narrowing, but also as a consequence of increased LSP dimensions.
Purpose
To observe the safety and efficacy of a minimally destructive decompressive technique without fusion in patients with lumbar stenosis secondary to degenerative spondylolisthesis.
Methods
30 patients with degenerative spondylolisthesis (DS) were consecutively managed by a single consultant spinal surgeon. All patients presented with neurogenic claudication secondary to DS. All patients were managed operatively with lumbar decompression utilising an approach technique of “spinous process osteotomy” (1). Briefly, this approach requires only unilateral muscle stripping with preservation of the interspinous ligament. A standard centrolateral decompression is then performed. Data consisting of VAS back and leg pain and ODI were collected pre and post-operatively.
Introduction Central placement of a total disc arthroplasty (TDA) in the coronal plane will result in equivalent facet joint loading, less tendency for lateral core migration, optimum kinematics, and better outcomes. This study was performed to determine which of the radiographic markers – the vertebral body, the pedicles, or the
Aims. To report the development of the technique for minimally invasive lumbar decompression using robotic-assisted navigation. Methods. Robotic planning software was used to map out bone removal for a laminar decompression after registration of CT scan images of one cadaveric specimen. A specialized acorn-shaped bone removal robotic drill was used to complete a robotic lumbar laminectomy. Post-procedure advanced imaging was obtained to compare actual bony decompression to the surgical plan. After confirming accuracy of the technique, a minimally invasive robotic-assisted laminectomy was performed on one 72-year-old female patient with lumbar spinal stenosis. Postoperative advanced imaging was obtained to confirm the decompression. Results. A workflow for robotic-assisted lumbar laminectomy was successfully developed in a human cadaveric specimen, as excellent decompression was confirmed by postoperative CT imaging. Subsequently, the workflow was applied clinically in a patient with severe spinal stenosis. Excellent decompression was achieved intraoperatively and preservation of the dorsal midline structures was confirmed on postoperative MRI. The patient experienced improvement in symptoms postoperatively and was discharged within 24 hours. Conclusion. Minimally invasive robotic-assisted lumbar decompression utilizing a specialized robotic bone removal instrument was shown to be accurate and effective both in vitro and in vivo. The robotic bone removal technique has the potential for less invasive removal of laminar bone for spinal decompression, all the while preserving the
Purpose: Rogers’ wiring is the most generally used method as stabilization of the cervical distractive-flexion injuries. When there is fracture of the
Objective: Infants introduced to indoor heated swimming pools in the first year of life show an association with progressive adolescent idiopathic scoliosis (AIS). Similarly control children exposed in this way show an association with vertical
Dimensions of the 60 male human lumbar vertebrae were quantified on their digitalised lateral images, and related to them across the five vertebral levels (range of 20–40 years). Vertebra dimensions’ were defined and referred to the upper endplate. Linear dimensions (mm) were: the length of the whole vertebra and of the
Hip instability is one of the most common causes for total hip arthroplasty (THA) revision surgery. Studies have indicated that lumbar fusion (LF) surgery is a risk factor for hip dislocation. Instrumented spine fusion surgery decreases pelvic tilt, which might lead to an increase in hip motion to accommodate this postural change. To the best of our knowledge, spine-pelvis-hip kinematics during a dynamic activity in patients that previously had both a THA and LF have not been investigated. Furthermore, patients with a combined THA and LF tend to have greater disability. The purpose was to examine spine-pelvis-hip kinematics during a sit to stand task in patients that have had both THA and LF surgeries and compare it to a group of patients that had a THA with no history of spine surgery. The secondary purpose was to compare pain, physical function, and disability between these patients. This cross-sectional study recruited participants that had a combined THA and LF (n=10; 6 females, mean age 73 y) or had a THA only (n=11; 6 females, mean age 72 y). Spine, pelvis, and hip angles were measured using a TrakSTAR motion capture system sampled at 200 Hz. Sensors were mounted over the lateral thighs, base of the sacrum, and the
Introduction: Little is known about how the cervical spine resists the high complex loading to which it is often subjected in life. In this study, such loading was applied to cadaveric cervical motion segments in order to a) measure their strength in forward and backwards bending, b) indicate which structures resist bending most strongly, and c) indicate how compressive injury influences the bending properties. Methods: Ten human cervical spines aged 65–88yrs were obtained post-mortem, dissected into 14 motion segments, and stored at −20°C. Subsequently, motion segments were defrosted and secured in dental plaster for testing on a hydraulic materials testing machine. An optical motion capture system recorded specimen movement simultaneously. Specimens were loaded in 2.5sec in combined bending and compression to reach their elastic limit in flexion, and then extension. Experiments were repeated following creep loading, removal of
Introduction: Neck hyperextension (NH) is defined as a progressive increase of lordosis associated with a limitation in flexion of the cervical spine, which ultimately results in an inability to approximate the chin to the sternum. NH may occur in relation to several myopathies. It is characterized by a general weakness and contractures of the axial muscles which produces a progressive increase of lordosis associated with a limitation in flexion of the cervical spine, that forces the patient to assume awkward compensatory postures to maintain balance and level vision. This study reports on operative complications, the degree of correction, the achievement of a solid arthrodesis, the maintenance of the correction and the clinical assessment of 7 patients. Material and methods: Seven patients affected by various myophaties and NH were included. The mean age was 16.5 years (10–28 years). All underwent surgery, in which the paravertebral muscles were detached from the
Pedicle screws fixation to stabilize lumbar spinal fusion has become the gold standard for posterior stabilization. However their positioning remain difficult due to variation in anatomical shape, dimensions and orientation, which can determine the inefficacy of treatment or severe damages to close neurologic structures. Image guided navigation allows to drastically decrease errors in screw placement but it is used only by few surgeons due to its cost and troubles related to its using, like the need of a localizer in the surgical scenario and the need of a registration procedure. An alternative image guided approach, less expensive and less complex, is the using of patient specific templates similar to the ones used for dental implants or knee prosthesis. Like proposed by other authors we decided to design the templates using CT scans. (slice thickness of 2.0 mm). Template developing is done, for each vertebra, using a modified version of ITK-SNAP 1.5 segmentation software, which allow to insert cylinders (full or empty) in the segmented images. At first we segment the spine bone and then the surgeon chose screw axes using the same software. We design each template with two hollow cylinders aligned with the axes, to guide the insertion in the pedicle, adding contact points that fit on the vertebra, to obtain a template right positioning. Finally we realize the templates in ABS using rapid prototyping. After same in-vitro tests, using a synthetic spine (by Sawbones), we studied a solution to guarantee template stability with simple positioning and minimizing intervention invasiveness. Preliminary ex-vivo animal testing on porcine specimens has been conducted to evaluate template performance in presence of soft-tissue in place, simulating dissection and vertebra exposure. For verification, the surgeon examined post-operative CT-scans to evaluate Kirschner wires positioning. During the ex-vivo animal test sessions, template alignment resulted easy thanks to the
To describe a modification of the existing technique for C2 translaminar screw fixation that can be used for salvage in difficult cases. Bilateral crossing C2 laminar screws have recently become popular as an alternative technique for C2 fixation. This technique is particularly useful in patients with anomalous anatomy, as a salvage technique where other modes of fixation have failed or as a primary procedure. However, reported disadvantages of this technique include breach of the dorsal lamina and spinal canal, early hardware failure and difficulty in bone graft placement due to the position of the polyaxial screw heads. To address some of these issues, a modified technique is described. In this technique, the upper part of the
An automated system has been developed to measure three-dimensional back shape in scoliosis patients using structured light. The low-cost system uses a digital camera to acquire a photograph of a patient with coloured markers on palpated bony landmarks, illuminated by a pattern of horizontal lines. A user-friendly operator interface controls the lighting and camera and leads the operator through the analysis. The system presents clinical information about the shape of the patient’s deformity on screen and as a printed report. All patient data (both photographs and clinical results) are stored in an integral database. The database can be interrogated to allow successive measurements to be plotted for monitoring the deformity. The system is non-invasive, requiring only a digital photograph to be taken of the patient’s back. Identification of the bony landmarks allows all clinical data to be related to body axes. This reduces the effects of variability in patient stance. Measurement of a patient, including undressing, landmark marking and dressing, can be carried out in approximately 10 minutes. The clinical results presented are based on the old ISIS report. This includes:. transverse sections at 19 levels from vertebra prominens to sacrum. coronal views of the line of
In this outcome-based study, we reviewed the results of the modified Woodward procedure performed on 10 patients over the last 15 years in our unit. The indication for surgery was a unilateral Sprengel’s deformity, Cavendish grade II or III, in children aged 3 to 6 years. Follow-up times ranged from 1 to 15 years. The patients were assessed according to patient and relatives’ satisfaction, cosmesis and functional results. The modified Woodward procedure entailed a midline longitudinal incision over the