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Clinical anatomy of the lumbar spine and sacrum

Authors:
Trish Wallner-Schlotfeldt
Trish Wallner-Schlotfeldt
Trish Wallner-Schlotfeldt
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Book
Review
Clinical A nato m y of the
Lum ba r S pine a n d Sacrum
Third Edition:
By: Nikolai Bogduk
Publisher: Churchill Livingstone, 1997.
This is the third edition of an excellent
source relating to the anatomical, bio
chemical and pathological issues related
to the lumbar spine and sacrum. It is well
illustrated and presented, making it easy
to access relevant information. It is well
referenced and states scientific findings
clearly. It brings us a collection and an
analysis of the latest scientific research
regarding the clinical causes of low back
pain which is most enlightening.
Chapter 1 through to 12 deals exten
sively with the anatomical, biochemical
and biomechanical considerations of the
lumbar spine and sacrum. The effects of
age in the lumbar spine is dealt with in
an informative way. The chapter dealing
with the possible sources and causes of
low back pain is an excellent overview
of pertinent literature. He deals with the
anatomical areas that may cause back
pain which is essentia] to an understand
ing of the pathological processes at
work. It is through this understanding
that logical treatm ent can be offered. He
makes the observation that the most
popularly held clinical conditions which
are postulated to cause back pain such as
trigger points, ligament and muscle pain
are associated with the smallest amount
of scientific evidence. He discusses the
more well researched, and often less
popular hypothesis in detail. New
insights into these issues are explored in
a most accessible way. This is an essen
tial book for all physiotherapists involved
in the treatment and long term rehabi
litation of people with pain related to
lum bar spine and/or sacrum.
Reviewed by: Trish Wallner - Schlotfeldt
38 SA Jo urnal of Physiotherapy 2000 Vol 56 No 3
Reproduced by Sabinet Gateway under licence granted by the Publisher (dated 2013.)
... The angle of the joint was defined by two lines which were the sagittal line versus the line through anteromedial and posterolateral ends of joint cavity (C and J shaped joints), or the line of inferior process (straight joints), in the slice through the intervertebral disc. Tropism was the reduction between the right and left angle of one level [6]. ...
... This study showed the Cshaped joint was predominant (Table 3). According to our knowledge, there was only study of Horwitz (1940) which mentioned the distribution of facet joint shape in normal population [6]. The pattern of two distributions were quite identical, however the rates of C shape was higher in our study. ...
The computed tomography characteristics of lumbar facet joints in spondylosis patients
Article
  • Mar 2023
Objective: To demonstrate the computed tomography (CT) features of lumbar facet joints in spondylosis patients. Subject and method: It was a cross-sectional and descriptive study including 42 spondylosis patients (416 lumbar facet joints) who took consultation in 108 Military Central Hospital, from December 2021 to July 2022. The subjects were recruited as the correspondence between Gomez Vega 2019 clinical criteria and CT scan. The examined index included: Joint shapes which were C-shaped, straight shape, J-shaped; joint angles regarding sagittal line; joint tropisms. Osteoarthritis characteristics of lumbar facet joints based on Pathria classification with 4 grades. Data were analyzed by SPSS, comparisons of two means were performed by T-test. Statistical significance was defined by p<0.05. Result: Average age of patients was 63.79 ± 2.24 years old, female/male ratio was 4.25. 2/42 (4.76%) patients had sacralization of L5. The proportions of joint shapes (C, straight and J) were 86.76%, 13.24%, 0% respectively. The angle of joints increased in respect of descending levels, from 31.14 ± 8.78o (L12) to 45.61 ± 11.20o (L5S1). The average of articular tropisms in each level were ranged from 5.47 ± 4.09o to 7.58 ± 7.22o. The percentages of Pathria classification (grade 0, 1, 2, 3) were 2.40%, 59.62%, 11.06%, 26.92%, respectively. Pathria 3 dominantly distributed at L45 level (Left 47.62% and right 42.86%). Subchondral sclerosis and hypertrophy contributed to the highest rate of degenerative characteristics (99.03% and 92.51% respectively). Conclusion: C-shaped joint was the most popular. Large tropism might be a consequence of prolonged osteoarthritis. Subchondral sclerosis and hypertrophy presented at almost facet joints. Pathria grade 3 was the most popular at L45 level which had higher percentage of severe osteoarthritis features.
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... In between the third and sixth weeks of pregnancy, during somitogenesis, the butterfly vertebra develops in utero [3,4]. The notochord is "compressed out" into the intervertebral disc, which results in the genesis of the nucleus pulposus [4]. ...
... In between the third and sixth weeks of pregnancy, during somitogenesis, the butterfly vertebra develops in utero [3,4]. The notochord is "compressed out" into the intervertebral disc, which results in the genesis of the nucleus pulposus [4]. The butterfly vertebral malformation occurs from the non-union of both sides of the vertebral body, which is thought to be caused by lingering remains of the notochord [5,6]. ...
An Incidental Finding of Butterfly Vertebrae in a Case of Vertebral Defects, Anal Atresia, Cardiac Defects, Tracheo-Esophageal Fistula, Renal Anomalies, and Limb Abnormalities (VACTERL)
Article
Full-text available
  • May 2023
Butterfly spine is a rare benign congenital abnormality. The onset of a minimum of three of the congenital malformations of vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities often characterises the VATER/VACTERL relationship. Recognising this anomaly is crucial for diagnosis, although this rare aberration is thought to be asymptomatic most of the time. Here we are describing a case of a one-year-old female child who has tetralogy of Fallot, congenital anal atresia, vesicovaginal fistula, and butterfly vertebrae which were found as an incidental finding. Furthermore we suggest screening all the children with any one abnormality of VACTERL, usually vertebral anomalies are screened.
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... This has the advantage of allowing for extensive bony and soft tissue decompression on the dorsal side of the nerve root and is similar to the practice of the authors (19)(20)(21)(22). Chronic inflammation and accumulated strain at the attachment point below the ligamentum flavum are major causes of ligamentum flavum thickening (9), and the lack of elasticity in the thickened ligamentum flavum can result in the dynamic stenosis of the vertebral canal (23). Following extensive dorsal bone decompression of the nerve root, the attachment point of the ligamentum flavum at the upper edge of the lamina can be removed and the hypertrophic and hypertrophic ligamentum flavum can be excised, all of which will alleviate the soft tissue compression on the dorsal side of the nerve root. ...
Percutaneous Transforaminal Endoscopic Decompression for Lumbar Lateral Recess Stenosis
Article
Full-text available
  • Aug 2021
Objective: The aim of this study was to evaluate the treatment efficacy of lateral spinal stenosis through the decompression of the nerve root under a multiple planar endoscope. Methods: From January 2017 to March 2019, 52 patients with lumbar spinal stenosis or lumbar spinal stenosis combined with intervertebral disc herniation had been treated via transforaminal approach spinal endoscopy. Our study retrospectively analyzed the treatment outcome. All patients experienced complications with different degrees of facet joint hyperplasia and ligamentum flavum hyperplasia and hypertrophy. Some patients suffered disc herniation. All patients were treated with percutaneous transforaminal approach multiple planar endoscopic decompression. The visual analog scale (VAS) and the Oswestry Disability Index (ODI) were compared before and after the operation, as were the horizontal foramen areas of the medial margins of the upper and lower pedicles of the vertebral arch. The treatment effectiveness was evaluated. Results: VAS and ODI scores were significantly improved at postoperative 3 days, 3 months, 6 months, and the last follow-up ( P < 0.05). The area of the intervertebral foramen was 422.5 ± 159.2 mm ² preoperatively and 890.8 ± 367.7 mm ² postoperatively, the difference was statistically significant ( P < 0.05). Conclusion: Percutaneous transforaminal approach multiple planar endoscopic decompression could achieve an accurate and effective decompression of the lumbar lateral spinal canal. This procedure has good short-term effects, and is especially suitable for elderly patients.
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Manual treatment for kidney mobility and symptoms in women with nonspecific low back pain and urinary infections
Article
Full-text available
  • Mar 2021
Context Recent studies have suggested a connection between low back pain (LBP) and urinary tract infections (UTI). These disturbances could be triggered via visceral-somatic pathways, and there is evidence that kidney mobility is reduced in patients suffering from nonspecific LBP. Manual treatment of the perinephric fascia could improve both kidney mobility and LBP related symptoms. Objectives To assess whether manual treatment relieves UTI and reduces pain in patients with nonspecific LBP through improvement in kidney mobility. Methods Records from all patients treated at a single physical therapy center in 2019 were retrospectively reviewed. Patients were included if they were 18 years of age or older, had nonspecific LBP, and experienced at least one UTI episode in the 3 months before presentation. Patients were excluded if they had undergone manipulative treatment in the 6 months before presentation, if they had one of several medical conditions, if they had a history of chronic pain medication use, and more. Patient records were divided into two groups for analysis: those who were treated with manipulative techniques of the fascia with thrust movement (Group A) vs those who were treated without thrust movement (Group B). Kidney Mobility Scores (KMS) were analyzed using high resolution ultrasound. Symptoms as reported at patients’ 1 month follow up visits were also used to assess outcomes; these included UTI relapse, lumbar spine mobility assessed with a modified Schober test, and lumbar spine pain. Results Of 126 available records, 20 patients were included in this retrospective study (10 in Group A and 10 in Group B), all of whom who completed treatment and attended their 1 month follow up visit. Treatments took place in a single session for all patients and all underwent ultrasound of the right kidney before and after treatment. The mean (± standard deviation) KMS (1.9 ± 1.1), mobility when bending (22.7 ± 1.2), and LBP scores (1.2 ± 2.6) of the patients in Group A improved significantly in comparison with the patients in Group B (mean KMS, 1.1 ± 0.8; mobility when bending, 21.9 ± 1.1; and LBP, 3.9 ± 2.7) KMS, p<0.001; mobility when bending, p=0.003; and LBP, p=0.007). At the 1 month follow up visit, no significant statistical changes were observed in UTI recurrence (secondary outcome) in Group A (−16.5 ± 4.3) compared with Group B (−20.4 ± 7) (p=0.152). Conclusions Manual treatments for nonspecific LBP associated with UTI resulted in improved mobility and symptoms for patients in this retrospective study, including a significant increase in kidney mobility.
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