INTRODUCTION: Lumbar hernia in the pediatric population is an extremely rare diagnosis and therefore requires specific diagnostic and therapeutic approaches. This case report describes the first published case of a pediatric lumbar hernia in the Czech Republic. CASE DESCRIPTION: A 22-month-old boy was examined at a pediatric surgical clinic due to a soft reducible mass in the right lumbar region, which, according to his mother, has been present from birth. An ultrasound scan confirmed a defect in the anatomical localization of the superior lumbar triangle (the triangle of Grynfeltt-Lesshaft) measur-ing 17 × 11 mm with a bowel loop herniation. The patient underwent a skeletal X-ray and an abdominal ultrasound in order to rule out associated malformations, following which he was scheduled for an open hernioplasty. Given the small size of the defect, a primary closure without mesh hernioplasty was performed. The postoperative course was uneventful and at clinical follow-ups the patient showed no signs of hernia recurrence or growth asymmetry. CONCLUSION: Lumbar hernia in children is congenital and frequently occurs with other associated malformations, which must be ruled out. The type of operation depends on the size of the defect and its purpose is to provide a tension-free closure.
- Klíčová slova
- associated anomalies, congenital lumbar hernia, mesh repair, surgical technique,
- MeSH
- abdominální hernie * vrozené chirurgie MeSH
- hernie * vrozené MeSH
- kojenec MeSH
- lidé MeSH
- lumbosakrální krajina * MeSH
- operace kýly MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
The purpose of this cross-sectional study was to present the values of maximal isometric lumbar extensor muscle strength (MILEMS) and lumbar extensor muscle endurance (LEME) in healthy subjects and to study the influence of physiological factors on these parameters. MILEMS using a hand-held dynamometer in three positions (prone, sitting, standing) and LEME using the Biering-Sørensen test were assessed in 115 healthy volunteers. The MILEMS measurements for the specific positions were correlated with each other (Pearson correlation coefficients 0.31-0.87, p < 0.001). In univariable linear regression, sex showed the highest effect on MILEMS prediction in sitting position (higher strength in men, P < 0.001, R2 of 20.4 %). Multivariable linear regression led to construction of a calculator to estimate predicted MILEMS in the sitting position in relation to sex, age and BMI with R2 of 32.2 %. LEME was mostly predicted by BMI (decrease of LEME with increasing BMI, P < 0.001), but multivariable regression analysis did not allow the construction of a reliable calculator to predict this parameter. In conclusion, we provided values for MILEMS and LEME. A calculator was developed to predict MILEMS and to determine the percentile of measured MILEMS in an individual. It is expected to be particularly useful in assessing patients who are likely to have lumbar extensor muscle impairment.
- Klíčová slova
- Dynamometer, Endurance, Low back pain, Muscle strength, Neuromuscular diseases, Paraspinal muscles, Spine,
- MeSH
- dospělí MeSH
- fyzická vytrvalost * fyziologie MeSH
- isometrická kontrakce * fyziologie MeSH
- kosterní svaly * fyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lumbosakrální krajina fyziologie MeSH
- mladý dospělý MeSH
- průřezové studie MeSH
- svalová síla * fyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Spinal fusion is a surgical procedure used to join two or more vertebrae to prevent movement between them. This surgical procedure is considered in patients suffering from a wide range of degenerative spinal diseases or vertebral fractures. The success rate of spinal fusion is frequently evaluated subjectively using X-ray computed tomography. The pig was chosen as an animal model for spinal fusion, since its spinal structure is similar to the human spine. Our paper presents an automatic approach for pig's spinal fusion evaluation in 3D. The proposed approach is based on the determination of the vertebral fused area, which reflects the fusion quality. The approach was applied and tested on microCT (μCT) data of fused porcine vertebrae ex-vivo. In our study, three types of implants were used to perform spinal fusion: the iliac crest bone graft used as the gold standard, and two types of novel scaffold implants based on the polymer/ceramic porous foam involving either growth factors or polyphosphates. The evaluation worked automatically for all three types of used implants, and the fusion quality was determined quantitatively. The calculation is based on the detection of the fused area and area of facies intervertebralis, so the percentual representation of the vertebral joint can be determined. Since this approach is versatile and is described in detail as a guide for image processing the data of vertebrae fusion, this methodology has the potential to establish a standard approach for evaluating the fusion quality in ex-vivo samples that can be tested on clinical data.
- Klíčová slova
- Computed tomography, Image processing, Lumbar spinal surgery, Regenerative medicine, Spinal fusion, Vertebrae fusion,
- MeSH
- bederní obratle diagnostické zobrazování chirurgie MeSH
- fúze páteře * MeSH
- lidé MeSH
- lumbosakrální krajina MeSH
- nemoci páteře * MeSH
- prasata MeSH
- rentgenová mikrotomografie MeSH
- rentgenové záření MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Spontaneous spinal epidural hematoma (SSEH) is a very rare clinical entity with potential diagnostic difficulties and which can result in severe neurological deficit. The etiology of this rare condition is largely not known, but with potential predisposition in patients on anticoagulation medication. This includes the novel anticoagulants with direct inhibition of the factor Xa mechanism (DOACs). These medications are supposed to have more predictable pharmacokinetics with fewer severe haemorrhagic adverse events in comparison with standard warfarin therapy. However, in the last few years, an increasing number of case reports have been published of haemorrhage into the central nervous system. We present a case of non-traumatic spinal epidural hematoma in the lumbar region in a patient on chronic apixaban therapy. To the best of our knowledge, it is the first described SSEH in the lumbar region associated with apixaban therapy.
- Klíčová slova
- Anticoagulation, Apixaban, Non-traumatic spinal epidural hematoma, Novel oral anticoagulants,
- MeSH
- antikoagulancia MeSH
- lidé MeSH
- lumbosakrální krajina MeSH
- magnetická rezonanční tomografie MeSH
- pyrazoly škodlivé účinky MeSH
- pyridony škodlivé účinky MeSH
- spinální epidurální hematom * chemicky indukované diagnostické zobrazování MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- Názvy látek
- antikoagulancia MeSH
- apixaban MeSH Prohlížeč
- pyrazoly MeSH
- pyridony MeSH
The goal was to prove that when a cohort of patients is chosen precisely, dorsal column stimulation provides significant improvement to quality of life. We studied a cohort of 50 patients with the history of failed back surgery syndrome coupled with epidural fibrosis (EF). A percutaneous implantation technique was used in each of the 50 patients. The study group was composed of 20 women and 28 men aged 26-67 years (mean age 49). A prospective observational questionnaire-based study was used. According to the methods, Ross's classification was adjusted to four degrees of scar size for our study objective. Despite this adjustment, it was not possible to statistically evaluate our research, due to very similar results in Groups I, III and IV. Patients without epidural fibrosis were assigned to Group 0, and patients with EF of different ranges were assigned to Group 1. The mean change in visual analogue scale DeltaVAS after our division into Group 0 was 4.82; for Group 1 it was 6.13. Evaluation of EF and DeltaVAS correlation by paired t-test shows a statistically higher effect of spinal cord stimulation (SCS) in the epidural fibrosis group, compared to group 0 without postoperative epidural fibrosis (p=0.008). The extent of epidural fibrosis is an important factor for Failed back surgery syndrome (FBSS). FBSS is the basis for the existence of neuropathic pain after lumbar spinal surgery. There is clear evidence of a correlation between patients with epidural scar formation on MR scan and the effect of dorsal column stimulation.
- MeSH
- dospělí MeSH
- epidurální prostor diagnostické zobrazování patologie MeSH
- failed back surgery syndrom komplikace MeSH
- fibróza terapie MeSH
- jizva MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lumbalgie MeSH
- lumbosakrální krajina MeSH
- magnetická rezonanční tomografie MeSH
- měření bolesti MeSH
- míšní stimulace metody MeSH
- neuralgie terapie MeSH
- pooperační komplikace diagnostické zobrazování terapie MeSH
- prospektivní studie MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- srovnávací studie MeSH
MR tractography of the lumbosacral plexus (LSP) is challenging due to the difficulty of acquiring high quality data and accurately estimating the neuronal tracts. We proposed an algorithm for an accurate visualization and assessment of the major LSP bundles using the segmentation of the cauda equina as seed points for the initial starting area for the fiber tracking algorithm.Twenty-six healthy volunteers underwent MRI examinations on a 3T MR scanner using the phased array coils with optimized measurement protocols for diffusion-weighted images and coronal T2 weighted 3D short-term inversion recovery sampling perfection with application optimized contrast using varying flip angle evaluation sequences used for LSP fiber reconstruction and MR neurography (MRN).The fiber bundles reconstruction was optimized in terms of eliminating the muscle fibers contamination using the segmentation of cauda equina, the effects of the normalized quantitative anisotropy (NQA) and angular threshold on reconstruction of the LSP. In this study, the NQA parameter has been used for fiber tracking instead of fractional anisotropy (FA) and the regions of interest positioning was precisely adjusted bilaterally and symmetrically in each individual subject.The diffusion data were processed in individual L3-S2 nerve fibers using the generalized Q-sampling imaging algorithm. Data (mean FA, mean diffusivity, axial diffusivity and radial diffusivity, and normalized quantitative anisotropy) were statistically analyzed using the linear mixed-effects model. The MR neurography was performed in MedINRIA and post-processed using the maximum intensity projection method to demonstrate LSP tracts in multiple planes.FA values significantly decreased towards the sacral region (P < .001); by contrast, mean diffusivity, axial diffusivity, radial diffusivity and NQA values significantly increased towards the sacral region (P < .001).Fiber tractography of the LSP was feasible in all examined subjects and closely corresponded with the nerves visible in the maximum intensity projection images of MR neurography. Usage of NQA instead of FA in the proposed algorithm enabled better separation of muscle and nerve fibers.The presented algorithm yields a high quality reconstruction of the LSP bundles that may be helpful both in research and clinical practice.
- MeSH
- algoritmy MeSH
- anizotropie MeSH
- cauda equina diagnostické zobrazování MeSH
- difuzní magnetická rezonance metody MeSH
- dospělí MeSH
- lidé MeSH
- lumbosakrální krajina inervace MeSH
- magnetická rezonanční tomografie metody MeSH
- míšní nervy anatomie a histologie diagnostické zobrazování MeSH
- plexus lumbosacralis diagnostické zobrazování MeSH
- počítačové zpracování obrazu metody MeSH
- zobrazování difuzních tenzorů metody MeSH
- zobrazování trojrozměrné přístrojové vybavení MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
INTRODUCTION: The author presents a case report of a rare lumbar hernia. CASE REPORT: A 69 years old woman came to our outpatient room with a big mass in the right lumbar area. The CT scan revealed a big lumbar hernia containing the right kidney, the colon and small intestine. The patient underwent an uneventful open hernioplasty with the use of a prolene mesh. CONCLUSION: Lumbar hernia occurs very rarely. Open hernioplasty with the use of a mesh is the method of choice in big hernias. Small hernias can be repaired laparoscopically.
The most serious complication of renal biopsy is vascular damage with subsequent haemorrhage. To our knowledge, we present a first ever case of lumbar artery (LA) rupture accompanied by massive retroperitoneal bleeding, which developed after a significant amount of time following the biopsy itself. In a 63-year-old Caucasian female patient, a percutaneous left kidney biopsy was performed under continuous ultrasound guidance. On the fourteenth day after the procedure, she was examined for a sudden onset of left lumbar region pain. Computed tomography angiography showed a large retroperitoneal hematoma with active bleeding from the fourth left LA. Successful endovascular superselective embolization was performed immediately. The predisposing factor for the late haemorrhage could have been anticoagulation therapy, renal insufficiency and older age. Our case report highlights the need for caution, especially when performing kidney biopsy in a group of high-risk patients, particularly if they are indicated for subsequent anticoagulant therapy.
- MeSH
- arterie zranění MeSH
- biopsie škodlivé účinky MeSH
- časové faktory MeSH
- krvácení etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lumbosakrální krajina krevní zásobení MeSH
- pooperační komplikace etiologie MeSH
- retroperitoneální prostor MeSH
- ruptura etiologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
PURPOSE: The aim of this study was to determine the incidence of congenital malformations of the lumbosacral transitional vertebrae in the general population, and the differences in their gender and left/right distributions. METHODS: The examined group comprised of all patients who underwent a pelvic X-ray during 2010 for any reason. The observed parameters included the following malformations: the presence of megatransversus at L5; sacralization of L5 or L6; a S1 lumbarization; the presence of six sacral vertebrae; or spina bifida at the level of L5, S1 or S2. In cases of megatransversus at L5, the lateral distribution was recorded. A total of 1,513 images were evaluated. Sex and lateral differences were evaluated using the Pearson's (χ (2)) test with a significance level of 5 %. RESULTS AND CONCLUSIONS: A total of 478 malformations were found in 417 patients, which constituted 27.6 % of the entire group. Malformations occurred in 250 women (25.4 % of all women) and 167 men (31.6 % of all men) and the female to male ratio in affected individuals was 1.5:1. The predominance of the occurrence of malformations observed in men was statistically significant (p = 0.009). The most frequently occurring malformations were the presence of six sacral vertebrae (179 patients) and megatransversus at L5 (150 patients). The study confirmed a high incidence of congenital malformations in the area of the lumbosacral transitional vertebrae and demonstrated a higher incidence in males. Unilaterally occurring megatransversus at L5 was significantly more common on the left side.
- MeSH
- dítě MeSH
- dospělí MeSH
- incidence MeSH
- kojenec MeSH
- lidé středního věku MeSH
- lidé MeSH
- lumbosakrální krajina abnormality diagnostické zobrazování MeSH
- mladiství MeSH
- muskuloskeletální abnormality diagnostické zobrazování epidemiologie MeSH
- předškolní dítě MeSH
- radiografie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- sexuální faktory MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- kojenec MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika epidemiologie MeSH
BACKGROUND: Current research implicates interleukin (IL)-6 as a key component of the nervous-system response to injury with various effects. METHODS: We used unilateral chronic constriction injury (CCI) of rat sciatic nerve as a model for neuropathic pain. Immunofluorescence, ELISA, western blotting and in situ hybridization were used to investigate bilateral changes in IL-6 protein and mRNA in both lumbar (L4-L5) and cervical (C7-C8) dorsal root ganglia (DRG) following CCI. The operated (CCI) and sham-operated (sham) rats were assessed after 1, 3, 7, and 14 days. Withdrawal thresholds for mechanical hyperalgesia and latencies for thermal hyperalgesia were measured in both ipsilateral and contralateral hind and fore paws. RESULTS: The ipsilateral hind paws of all CCI rats displayed a decreased threshold of mechanical hyperalgesia and withdrawal latency of thermal hyperalgesia, while the contralateral hind and fore paws of both sides exhibited no significant changes in mechanical or thermal sensitivity. No significant behavioral changes were found in the hind and fore paws on either side of the sham rats, except for thermal hypersensitivity, which was present bilaterally at 3 days. Unilateral CCI of the sciatic nerve induced a bilateral increase in IL-6 immunostaining in the neuronal bodies and satellite glial cells (SGC) surrounding neurons of both lumbar and cervical DRG, compared with those of naive control rats. This bilateral increase in IL-6 protein levels was confirmed by ELISA and western blotting. More intense staining for IL-6 mRNA was detected in lumbar and cervical DRG from both sides of rats following CCI. The DRG removed from sham rats displayed a similar pattern of staining for IL-6 protein and mRNA as found in naive DRG, but there was a higher staining intensity in SGC. CONCLUSIONS: Bilateral elevation of IL-6 protein and mRNA is not limited to DRG homonymous to the injured nerve, but also extended to DRG that are heteronymous to the injured nerve. The results for IL-6 suggest that the neuroinflammatory reaction of DRG to nerve injury is propagated alongside the neuroaxis from the lumbar to the remote cervical segments. This is probably related to conditioning of cervical DRG neurons to injury.
- MeSH
- ELISA MeSH
- funkční lateralita fyziologie MeSH
- fyzikální stimulace MeSH
- hybridizace in situ MeSH
- hyperalgezie metabolismus MeSH
- imunohistochemie MeSH
- interleukin-6 biosyntéza genetika MeSH
- krční obratle MeSH
- krysa rodu Rattus MeSH
- lumbosakrální krajina MeSH
- měření bolesti MeSH
- messenger RNA biosyntéza genetika MeSH
- nemoci sedacího nervu metabolismus MeSH
- neuralgie metabolismus MeSH
- počítačové zpracování obrazu MeSH
- potkani Wistar MeSH
- receptory interleukinu-6 biosyntéza genetika MeSH
- spinální ganglia metabolismus MeSH
- stenóza MeSH
- úžinové syndromy metabolismus MeSH
- vysoká teplota MeSH
- western blotting MeSH
- zvířata MeSH
- Check Tag
- krysa rodu Rattus MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- interleukin-6 MeSH
- messenger RNA MeSH
- receptory interleukinu-6 MeSH
