Percutaneous epidural and nerve root block and percutaneous lumbar sympatholysis

Epidural steroid injections and selective nerve root blocks currently are considered standard techniques in the diagnosis and treatment of back pain. The targeted epidural and perineural steroid injection with nerve block is a new technique that combines an epidural steroid injection and a nerve block. Radiologists are best suited for performing these procedures because of their training and skills in fluoroscopy and needle procedures.     

Lumbar osteoarthritis

Lumbar osteoarthritis involves both the disc and the facet joints. Measurements of the disc space evaluates the degeneration. There is no radio-clinical correlation at a given time. There are however inflammatory phases in facets arthrosis and discolysis with disc narrowing within few months. These attacks are responsive to NSAID'S and local injections of corticosteroids. The chronic back pain needs only analgesics and rehabilitation. Osteophytes can narrow the spinal canal and induce back and leg pains. Except neurological weakness and bladder dysfunction the medical treatment should be prolonged before the indication of surgery.     

Lumbar spinal stenosis

Tumors of perineurial origin are rare. Three variants of perineuriomas have been described, a storiform perineurial fibroma, an intraneural perineurioma, and a recently described sclerosing perineurioma. We present two patients with cutaneous fibrous perineurioma located in acral areas. Both tumors had a deep circumscribed margin with a prominent vascular component. They contained small round cells and spindle cells that express EMA and show membrane staining for type IV collagen. Cutaneous fibrous perineuriomas fit within the spectrum of neurocristicly derived cellular proliferations.     

Thermoregulated radiofrequency endometrial ablation

OBJECTIVE: To test the hypothesis that treating dysfunctional uterine bleeding by automated application of electrothermal energy to the uterine cavity, with precise regional control, might yield results equivalent to those reported for hysteroscopically directed laser and electrosurgical endometrial ablations. MATERIALS AND METHODS: Patients with life style compromising menorrhagia, referred to six gynecologic surgical centers for hysterectomy or endometrial ablation, were admitted to the study if they had normal cervical cytology, a benign endometrial biopsy, no defined cause for their bleeding, and consented to participate in the evaluation of a newly developed Vesta DUB Treatment System. The device consists of a silicone-inflatable electrode carrier to be inserted into the uterine cavity and a controller to monitor and distribute current from a matched electrosurgical generator. Treatment involved a 3-minute or shorter warm-up period and a 4-minute treatment phase. RESULTS: Three- to 24-month follow-up data were available for 187 patients, with a mean follow-up of 14.8 months. The amenorrhea rate was 38%. Bleeding was reduced in 95% of patients. Actuarially, 88 +/- 3% of patients should expect to be free of menorrhagia, dissatisfaction, or need for a second procedure out to 24 months. CONCLUSIONS: The unique regional feed-back control offered by this system causes thorough, evenly distributed, thermal destruction 4-5 mm into the myometrium that reduces bleeding with durability equivalent to published reports of hysteroscopic endometrial ablation.     

Lumbar percutaneous endoscopic interbody fusion

Since 1982, percutaneous endoscopic control has been found to be a fundamental help for selective posterior subligamentary decompression in lumbar contained disc herniations. After the first clinical experience in 1986 with percutaneous intervertebral bone grafting, the need for sufficient percutaneous preparation of the adjacent vertebral plates and postoperative immobilization of the operated on segment became evident. So in 1988, the original eccentrically abrasive end plate cutter for application under discoscopy was introduced. For a preoperative trial and postoperative stabilization, the complementary use of the external pedicle fixation device was standardized in 1988. The use of percutaneous autologous bone interposition was found essential for optimal bony interbody consolidation. The indications were limited strictly to monosegmental lumbar dysfunctions without a need for peridural decompression. In a series of 37 patients with standardized procedure and a mean followup of 33 months, bony interbody consolidation was achieved in 30 cases. The technique desists from any need for blood transfusion, and functional rehabilitation is facilitated because of the very limited percutaneous approach.     

Lumbar puncture in meningitis?

Two young siblings who presented with an unusual recurrent severe thromboembolic phenomenon were found to have familial anti-phospholipid syndrome and were heterozygous for the factor V R506Q mutation. The coexistence of hereditary and acquired APC-resistance may explain the severity of thromboembolism.     

Thermal latency in radiofrequency ablation

The relative nail producing capacity of different regions within the nail matrix has not been quantified. In order to do this, the number of nail plate cells in the dorsoventral axis of 12 human great toenails was counted at five sites in the longitudinal axis, and compared with direct measurements of nail plate thickness at the same sites. The mean number of nail cells in the nail plate reached a maximum at the lunula, with no further increase along the length of the nail bed. At the mid-point between the proximal tip of the germinal matrix and lunula, mean cell numbers achieved 81% of the value at the lunula. Mean nail thickness was only 90% of its maximum at the lunula, with a further significant increase (P = 0.02) between the lunula and end of the nail bed. These observations suggest that the proximal nail matrix is the main source of nail within the matrix. This is consistent with clinical experience where distal matrix surgery has a low potential for scarring in comparison with proximal matrix surgery. The additional finding of increased nail thickness, but not cell numbers, along the nail bed make it likely that cells within the nail plate change shape as they move distally.     

Lumbar intervertebral disk herniation in children

A consecutive series of 16 children from 9 to 18 years old, with lumbar intervertebral disc herniation who were treated surgically in Department of Neurosurgery Medical Academy in Poznań, between 1978-1992, was analysed. The clinical symptoms, X-ray assessment, type of operation and outcome are reviewed. In our analysis characteristic features of disc herniation in children are: the onset of pain due to violent injury in relation to lifting, bilateral neurological symptoms and radiculography imaging central intervertebral disc herniation.     

A simple method for investigating the effects of non-uniformity of radiofrequency transmission and radiofrequency reception in MRI

Inhomogeneity of the transmitted or received B1 field leads to intensity variations in MR images and spatial dependence in apparent concentration in MR spectra. We describe a simple method for investigating such variations. The transmitted B1 field can be measured both in vivo and in vitro which allows investigation of sample dependent effects that can not be measured on phantoms. For homogeneous regions the method also allows the received B1 field to be measured both in vivo and in vitro. Our method uses only a standard spin echo pulse sequence and simple region of interest analysis and should be implementable on any commercial scanner. The method is demonstrated using a variety of transmission and reception radiofrequency coils both in vivo and in vitro.     

Lumbar disc degeneration in relation to occupation

Angiogenic growth factors are essential for cancer metastasis, and the growth of metastatic foci also depends on these angiogenic growth factors as well as autocrine or paracrine growth factors. We therefore investigated whether vascular endothelial growth factor (VEGF) and thymidine phosphorylase (dThdPase) are localized more often in primary tumors with hepatic metastasis than in those without such metastasis and whether transforming growth factor (TGF-alpha) and epidermal growth factor receptor (EGF-R) are coexisted more often in hepatic metastases than in primary tumors of gastric cancer. Resected specimens from 82 patients with gastric cancer were examined immunohistochemically. The primary antibodies used were anti-VEGF, anti-dThdPase, anti-TGF-alpha and anti-EGF-R. VEGF expression was found to be higher in primary cancers with than in those without hepatic metastasis (p < 0.001), while VEGF was frequently observed in both hepatic metastases and in the primary tumors. Localization of dThdPase was also higher in advanced than in early gastric cancers (p = 0.021). High co-presence of TGF-alpha and EGF-R was detected more frequently in cancers with deep gastric wall invasion than in those without such invasion (p = 0.050), and also more often in cancers with venous invasion (p = 0.007) and those in the advanced stage (p = 0.020). Co-presence of TGF-alpha and EGF-R was found to be higher, though not significantly, in hepatic metastases (58.8%) than in primary tumors (29.4%). These findings suggest that localization of VEGF may play an important role in hepatic metastasis, and that the expression of VEGF, dThdPase and the TGF-alpha/EGF-R pathway may be responsible for the growth of hepatic metastasis.     

Lumbar zygapophysial (facet) joint injections

The lumbar zygapophysial joints are a potential cause of back and lower extremity pain. Absolute diagnosis of lumbar zygapophysial joint-mediated pain is based on selective analgesic injections of these joints or their nerve supply. The therapeutic role of zygapophysial joint injections is controversial. This contemporary concepts paper reviews the anatomy, mechanics, pathology, and diagnosis of this condition. A critical review of previous studies assessing the role of diagnostic and potentially therapeutic zygapophysial joint injection procedures is presented. The need for future studies is addressed, and current recommendations for the role of zygapophysial joint injection procedures based on this critical scientific review are provided.     

Lumbar spinal stenosis in an elderly patient

BACKGROUND: The general population is aging, and lumbar stenosis is one of the more frequent conditions observed in an orthopedic or neurosurgical practice. METHODS: This case presentation is of an 86-year-old male who developed lumbar spinal stenosis with a progressive neurologic deficit that caused severe leg pain, affected bladder function, and affected gait. Relevant medical literature is reviewed. RESULTS: Bladder function and gait returned after spinal surgery, and this patient's pain was greatly reduced. A multidisciplinary team applied therapy after surgery. The medical literature does not concentrate solely upon patients older than 80, but a few are included in studies of younger patients. CONCLUSIONS: This case report illustrates that a patient over 80 can have a successful outcome with multidisciplinary medical coverage of medical, surgical, rehabilitative, social, and psychological areas. More studies need to be done of these patients.