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Hemilaminectomy and laminectomy are decompressive procedures commonly used in case of lumbar spinal stenosis, which involve the removal of the posterior elements of the spine. These procedures may compromise the stability of the spine segment and create critical strains in the intervertebral discs. Thus, this study aimed to investigate if decompressive procedures could alter the biomechanics of the lumbar spine. The focus was on the changes in the range of motion and strain distribution of the discs after two-level hemilaminectomy and laminectomy. Twelve L2-S1 cadaver specimens were prepared and mechanically tested in flexion, extension and both left and right lateral bending, in the intact condition, after a two-level hemilaminectomy on L4 and L5 vertebrae, and a full laminectomy. The range of motion (ROM) of the entire segment was assessed in all the conditions and loading configurations. In addition, Digital Image Correlation was used to measure the strain distribution on the surface of each specimen during the mechanical tests, focusing on the disc between the two decompressed vertebrae and in the two adjacent discs. Hemilaminectomy did not significantly affect the ROM, nor the strain on the discs. Laminectomy significantly increased the ROM in flexion, compared to the intact state. Laminectomy significantly increased the tensile strains on both L3-L4 and L4-L5 disc (p = 0.028 and p = 0.014) in ipsilateral bending, and the compressive strains on L4-L5 intervertebral disc, in both ipsilateral and contralateral bending (p = 0.014 and p = 0.0066), with respect to the intact condition. In conclusion, this study found out that hemilaminectomy did not significantly impact the biomechanics of the lumbar spine. Conversely, after the full laminectomy, flexion significantly increased the range of motion and lateral bending was the most critical configuration for largest principal strain.

Context: Low back pain (LBP) is a symptom of many lumbosacral spine abnormalities which are prevalent in all occupational groups in our environment. Its frequency and severity are significantly related to age and gender. Aims: To determine the relationship between age, gender and LBP in patients referred for magnetic resonance imaging (MRI) of lumbosacral spine. Settings and Design: A cross sectional study at Ahmadu Bello University Teaching Hospital, Zaria. Materials and Methods: The study was conducted within 4 years at the MRI suite of the Department of Radiology, on 200 patients who had LBP who had MRI scan. Statistical analysis used: Data from the questionnaires were sorted and entered into Microsoft Excel. Analysis was performed using the Statistical Package for Social Sciences Version 22.0. Results: There is male preponderance, with a male to female ratio of 1.6:1. The ages ranged from 11 to 80 years, with a mean of 47.8 + 1.4, and the peak incidence (55 [27.5%]) is in the fourth and fifth decades of life. A statistically significant association (χ2 = 33.9; P < 0.001) was also found between the severity of LBP and ageing. Majority of the patients (172 [86%]) had intervertebral disc prolapse/herniation, out of which 104 (60.5%) were males and 68 (39.5%) were females. Conclusion: Patients with lumbar disc prolapse had early age incidence with male preponderance. The incidence of lower level disc involvement was more, and there was no significant decadal difference in presentation, when both protruded and extruded types of disc prolapse were compared to age and gender. [ABSTRACT FROM AUTHOR]

Introduction: Image guided interventions are increasingly being used for the management of chronic low back ache. It has inherent advantages of confirming needle placement and thus increasing precision of these procedures. Aim: To assess the efficacy of pain relief provided by CT guided perineural and CT guided facet joint steroid injections respectively in patients with chronic spinal pain. Materials and Methods: A prospective study was performed to analyse the effect of image guided procedures in providing adequate pain relief. Patients were asked to grade pain on a Visual Analog Scale (VAS) for pain before the procedure as well as on subsequent reviews at 3 days, 30 days and 90 days. The pain score was used to calculate percentage of pain relief since previous follow-up and classified accordingly. Results: A total of 67 perineural injections and 20 facetal injections were administered. In present study, out of 67 perineural injections at least 31.5% reported very good pain relief as early as 3 days post-injection, while 28.3% continued to have very good pain relief at the end of 30 days but this fell to 10.4% at the end of 90 days. Out of 20 facet joint injections, none of the patients reported good pain relief during the follow-up. Conclusion: CT-guided perineural steroid injections for management of chronic low back ache are safe and effective interventions that can be incorporated into any existing interventional radiology practice.

Introduction: Image guided interventions are increasingly being used for the management of chronic low back ache. It has inherent advantages of confirming needle placement and thus increasing precision of these procedures. Aim: To assess the efficacy of pain relief provided by CT guided perineural and CT guided facet joint steroid injections respectively in patients with chronic spinal pain. Materials and Methods: A prospective study was performed to analyse the effect of image guided procedures in providing adequate pain relief. Patients were asked to grade pain on a Visual Analog Scale (VAS) for pain before the procedure as well as on subsequent reviews at 3 days, 30 days and 90 days. The pain score was used to calculate percentage of pain relief since previous follow-up and classified accordingly. Results: A total of 67 perineural injections and 20 facetal injections were administered. In present study, out of 67 perineural injections at least 31.5% reported very good pain relief as early as 3 days post-injection, while 28.3% continued to have very good pain relief at the end of 30 days but this fell to 10.4% at the end of 90 days. Out of 20 facet joint injections, none of the patients reported good pain relief during the follow-up. Conclusion: CT-guided perineural steroid injections for management of chronic low back ache are safe and effective interventions that can be incorporated into any existing interventional radiology practice. [ABSTRACT FROM AUTHOR]

Introduction: About 40% of people have low back pain (LBP) at some point in their lives. Non specific LBP where precise pathoanatomical diagnosis cannot be given comprises almost 85% of patients with isolated low back pain. Lumbosacral radiograph is preferred by most of the physicians for the initial assessment of the LBP. It is therefore crucial to evaluate patients with LBP and assess for possible relationship between low back pain and patient characteristics. Methods: In the study, lumbosacral radiographs of 200 patients with nonspecific LBP coming to Radiology department of T.U. Teaching Hospital were reviewed between July to September 2014. The findings were classified under various categories, tabulated in the Proforma and data were analyzed using SPSS software system. Results: Among total of 200 patients, 45% (90) were male and 55% (110) were female. The study included patients of different age ranging from 13 to 92 years with highest number in 30-39 and 40-49 age groups accounting for each 23% of total population. Lumbar spondylosis, normal radiographs and loss of lumbar lordosis were the most common three findings comprising 105 (52.5%), 55 (27.2%) and 24 (12%) of radiographs respectively. Lumber spondylosis was the most common finding after the age of 30 years with highest in the age group of 60-69 years comprising 93.8 % (15) of radiographs in that age group. Most of the radiographs of younger patients below 30 years of age were normal. Conclusion: The study demonstrated that the occurrence of lumber spondylosis was the highest among the radiographs of patients with low back pain. The loss of lordosis and disk degeneration was also significant factors associated with low back pain. [ABSTRACT FROM AUTHOR]

Abstract: Background: Seated postures are achieved with a moderate amount of lumbo-sacral flexion and sustained lumbo-sacral spine flexion has been associated with detrimental effects to the tissues surrounding a spinal joint. The purpose of this study was to determine if the lower intervertebral joints of the lumbo-sacral spine approach their end ranges of motion in seated postures. Methods: Static sagittal digital X-ray images of the lumbo-sacral region from L3 to the top of the sacrum were obtained in five standing and seated postures from 27 participants. Vertebral body bony landmarks were manually digitized and intervertebral joint angles were calculated for the three lower lumbo-sacral joints. Findings: In upright sitting, the L5/S1 intervertebral joint was flexed to more than 60% of its total range of motion. Each of the lower three intervertebral joints approached their total flexion angles in the slouched sitting posture. These observations were the same regardless of gender. The results support the idea that lumbo-sacral flexion is driven by rotation of the pelvis and lower intervertebral joints in seated postures. Interpretation: This is the first study to quantitatively show that the lower lumbo-sacral joints approach their total range of motion in seated postures. While not directly measured, the findings suggest that there could be increased loading of the passive tissues surrounding the lower lumbo-sacral intervertebral joints, contributing to low back pain and/or injury from prolonged sitting. [Copyright &y& Elsevier]

Careful analysis of over 400 patients radiologically diagnosed with arachnoiditis showed a subgroup of eight patients with a specific set of imaging signs that suggest a pre-existing developmental abnormality mimicking the appearance of arachnoiditis. These cases have been collected over a 15-year period. No autopsy or surgical proof is available. All patients have (i) the presence of a well-defined midline septum in the sagittal plane that splits the thecal sac, usually symmetrically, in the lower lumbar or sacral region, below the level of the spinal cord; (ii) the absence of adjacent epidural fibrosis that one would expect if the septation had been caused by surgical intervention or trauma; (iii) the preservation of cerebrospinal fluid within the nerve root sheaths and around the nerve roots at the level of the septation; and in four cases (iv) the presence of either calcification or bone in this midline septum, yet nowhere else in the theca or epidural space. These cases suggest a developmental variant called, for want of a better term, ‘split lumbo-sacral thecal sac’ analogous to diastematomyelia but not involving the spinal cord. This variant is potentially confused with arachnoiditis or thecal scarring in the lumbo-sacral sac. [ABSTRACT FROM AUTHOR]

The implantation of a « Charité » prosthesis has to be solved through a biomechanical compromise between the size of the implants and it’s positioning in the intervertebral space. A retroperitoneal approach allows one to minimise complications and especially to see and protect the hypogastric nerve. Generally, the anatomy of the great vessels offers a wide approach on the anterior aspect of the disc, except in the case of a high bifurcation of the vena cava with a left iliac vena outside and over the iliac artery and having a straight downwards direction. This situation is infrequent, 1 for 1,000 anterior approaches in our experience. [ABSTRACT FROM AUTHOR]