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debated. In a subgroup of 38 children with AHT who underwent thoracolumbar spine imaging, 24 (63%) had thoracolumbar SDH, whereas only 1 of 70 ACR Appropriateness Criteria ® 6 Suspected Physical Abuse–Child patients with accidental trauma had spinal SDH in the same study . None of the children had spinal cord compression or long-term complications from the presence of the spinal SDH, and that imaging was performed mostly because of concern for thoracic or abdominal injury. Although not usually (...) prompting change in management, detection of spinal SDH is significantly increased when imaging is extended through the thoracolumbar spine . The presence of thoracolumbar SDH does not imply direct trauma to the thoracolumbar spine and may be related to redistribution of blood products. Nevertheless, this finding has medicolegal implications as it may document otherwise undetected injury and may help distinguish between abusive and accidental injury. CT chest without contrast CT of the chest is more
Percutaneous cement augmentation for osteoporotic vertebral fractures Thoracolumbar vertebral fracture incidents usually occur secondary to a high velocity trauma in young patients and to minor trauma or spontaneously in older people.Osteoporotic vertebral fractures are the most common osteoporotic fractures and affect one-fifth of the osteoporotic population.Percutaneous fixation by 'vertebroplasty' is a tempting alternative for open surgical management of these fractures.Despite discouraging (...) , stressing the important aspects for success, and recommend a thorough evaluation of thoracolumbar fractures in osteoporotic patients to select eligible patients that will benefit the most from percutaneous augmentation. A detailed treatment algorithm is then proposed. Cite this article: EFORT Open Rev 2017;2:293-299. DOI: 10.1302/2058-5241.2.160057.
be effective for thoracolumbar afferents. However, it is difficult to obtain appropriate stimulation from SCS for the sacral nerves, including pudendal, thus limiting the use of this therapy in chronic pelvic pain management. Nevertheless, where a specific visceral cause has been determined, such as in endometriosis, there is a possibility that it does have some impact. In a small (n = 6) study by Kapural et al., 59 SCS was used to treat visceral pelvic pain after a successful test period with hypogastric (...) osteoarthritis. Cochrane Database Syst Rev 2013;(12):CD003523. 35. Jorgensen WA, Frome BM, Wallach C. Electrochemical therapy of pelvic pain: effects of pulsed electromagnetic fields (PEMF) on tissue trauma. Eur J Surg Suppl 1994;(574):83–6. 36. de Scisciolo G, Del Corso F, Caramelli R, Schiavone V, Cassardo A, Provvedi E, et al. P15.10 Effects of repetitive magnetic stimulation (rMS) in the treatment of chronic pelvic pain syndrome (CPPS) and floor dysfunction (FD). Clin Neurophysiol 2011;122 Supp 1:S129
in Patients Requiring Surgery for Spinal Instability: A Review of the Comparative Clinical and Cost-Effectiveness, and Guidelines DATE: 25 June 2015 CONTEXT AND POLICY ISSUES A wide range of conditions including degenerative spine diseases, spinal deformities, tumors, infection, and spine trauma can result in spinal instability. These conditions are also associated with back pain, disability, and decreased quality of life (QoL). Estimates of the economic burden of back pain in the USA is US$100 billion (...) pyogenic spondylitis, 25,32 post-laminectomy syndrome, 6,7,16,18,20,31 adjacent segment disease, 6,16,18,23,32 degenerative disc disease, 6,17-20,23,26,29,30,33 sagittal imbalance, 17 stenosis, 17,20,21,24,27,31,32 revision, 17 thoracolumbar fractures, 19 kyphosis due to disc degeneration, 19 post-traumatic kyphosis, 30 structured kyphosis, 19 recurrent disc herniation, 20 infective spondylitis, 21 instrumentation failure/nonunion, 6 prior variable screw placement instrumentation, 7 herniated nucleas
identified as a major cause for ventral CSF loss through vertical longitudinal dural slits. We report a rare case of intractable SIH due to an intradural disc herniation at the thoracolumbar junction (without signs of calcification) and its management.A 46-year old woman suffered from orthostatic headache (sudden onset, no history of trauma) due to intractable SIH for over 2 month (without neurologic deficits). There was no clinical amelioration by conservative measures (analgesics, bedrest) and serial (...) unspecific epidural blood patches (repeated for 3 times). She was diagnosed with an intradural disc herniation at the thoracolumbar junction causing a CSF leak. Surgical exploration by a translaminar and transdural approach with removal of the disc herniation and closure of the CSF leak was performed with immediate cessation of orthostatic symptoms. Histological workup revealed non-calcified intervertebral disc material. After 3 months of follow-up and no evidence for clinical relapse the patient
Isolated multiple lumbar transverse process fractures with spinal instability: an uncommon yet serious association. Isolated vertebral transverse process fractures of thoracolumbar spine without other vertebral injuries and neurological deficit are generally considered as minor injuries with no concern for associated spinal instability. This report describes a case of multiple lumbar transverse fractures associated with an unexpected yet clinically significant spinal instability.A young male (...) of the major soft-tissue stabilizers of the spine presenting subtle changes on CT images. When a seemingly benign spinal injury is caused by high-energy trauma, careful scrutiny for associated instability is needed. In this case, the standing in-brace X-ray was able to avoid a misdiagnosis and potentially unfavourable outcome.
by bony fracture. O X-ray spine 7 This procedure can be the first test in multisystem trauma, especially when CT is delayed. Flexion and extension views can be used to evaluate instability only if patient is not obtunded. ??? X-ray myelography and post myelography CT spine 5 MRI is preferable. ???? MRI spine without and with IV contrast 2 O CT spine with IV contrast 2 ??? Tc-99m bone scan with SPECT spine 2 ??? CT spine without and with IV contrast 1 ???? Rating Scale: 1,2,3 Usually not appropriate (...) to the thoracic spine, though this is less common. The next most common causes of myelopathy are spinal cord compression due to extradural masses caused by bone metastases and blunt or penetrating trauma. Many primary neoplastic, infectious, inflammatory, neurodegenerative, vascular, nutritional, and idiopathic disorders can also result in myelopathy, though these are much less common than discogenic disease, metastases, and trauma. A variety of cysts and benign neoplasms can also compress the cord; they tend
The primary aims for treatment of neuro-urological symptoms and their priorities are [101, 102]: • pr otection of the UUT ; • achievement of urinary continence; • r estoration of (parts of) the LUT function; • impr ovement of the patient’ s QoL. Further considerations are the patient’s disability, cost-effectiveness, technical complexity, and possible complications . Renal failure is the main mortality factor in SCI patients who survive the trauma [9, 103, 104]. Keeping the detrusor pressure during
Afferents in the autonomic plexus 46 6.3 Aetiology of nerve damage 46 6.3.1 Anterior groin nerves - aetiology of nerve damage 46 6.3.2 Pudendal neuralgia - aetiology of nerve damage 46 6.3.3 Surgery 46 6.3.4 Trauma 46 6.3.5 Cancer 46 6.3.6 Birth trauma 46 6.3.7 Elderly women 46 6.4 Diagnosis for pudendal neuralgia 47 6.4.1 Differential diagnosis of other disorders 47 6.4.2 Clinical presentation of pudendal neuralgia 47 126.96.36.199 Age 47 188.8.131.52 Sex 47 184.108.40.206 History 47 220.127.116.11 Associated features 48 (...) dysfunction in men 51 7.5 Chronic pelvic pain and sexual dysfunction in women 52 7.6 Treatment of sexual dysfunctions and CPP 53 7.7 Summary 53 7.8 Conclusions and recommendations: sexological aspects in CPP 53CHRONIC PELVIC PAIN - UPDATE APRIL 2014 5 8. PSYCHOLOGICAL ASPECTS OF CHRONIC PELVIC PAIN 54 8.1 Understanding the psychological components of pain 54 8.1.1 Neurophysiology of pain 54 8.1.2 Sexual abuse and trauma 54 8.1.3 Interpreting psychological differences 54 8.2 Psychological assessment
Posted : January 29, 2018 Last Update Posted : January 29, 2018 See Sponsor: Columbia University Information provided by (Responsible Party): Allen Chen, Columbia University Study Details Study Description Go to Brief Summary: This is a pilot study to lead to a larger prospective, randomized, controlled study of older adult (ages 50 and older) spinal patients with thoracolumbar/lumbar scoliosis evaluating improvement with physiotherapeutic scoliosis-specific exercise (PSSE) compared to traditional (...) ) Sexes Eligible for Study: All Accepts Healthy Volunteers: No Criteria Inclusion Criteria: 50+ years old Diagnosis of adolescent idiopathic scoliosis or adult idiopathic scoliosis; either with a Cobb angle ranging from 20-100 degrees Complaint of back pain that has lasted longer than 6 weeks Exclusion Criteria: Any patient who has completed PSSE in the past Previous spinal surgery, trauma, or presence of neoplasms Diagnosis of congenital or neuromuscular scoliosis Subjects who are involved
and characteristic of DISH by whole spinal CT.Participants were patients who had experienced trauma who had undergone whole-spine CT scanning based on the initial clinical practice guidelines for trauma in our institute from April 2015 to February 2018. The subjects were > 20 years old and 1479 were included in the analysis. The presence and distribution of DISH and clinical parameters such as age and sex were reviewed retrospectively according to the location of DISH.The overall prevalence of DISH was 19.5% (n (...) = 289). Subjects with DISH were older than those without. DISH was located in the thoracic spine in 65.1% and thoracolumbar spine in 24.2% of patients. More than 80% of ligamentous ossifications associated with DISH occurred at T8 (n = 255, 88%), T9 (n = 262, 91%), and T10 (n = 247, 85%). Most of the ossification occurred to the right anterior of the vertebral body, and there were few ossifications in the areas in contact with the artery and vein.The prevalence of DISH based on whole-spine CT
Epidemiology of vertebral fractures in pediatric and adolescent patients Spinal injuries in children and adolescents are rare injuries, but consequences for the growing skeleton can be devastating. Knowledge of accident causes, clinical symptoms and diagnostics should be part of every trauma department treating these patients. We retrospectively analyzed patients with radiographically proven vertebral fractures of the spine. After clinical examination and tentative diagnosis the fractures (...) and injuries were proven with conventional X-ray, computed tomography (CT) scans or magnetic resonance imaging (MRI). The study included 890 fractures in 546 patients with an average age of 12.8±6.2 (6.6-19.4) years. Females had an average age of 13.7±6.3 (7.4-20.0) years, whereas males were on average 12.0 (6.0-18.0) years old. Fall from height (58%) was the main cause of accident and the most common region of fracture was the thoracolumbar spine with a shift towards the thoracic spine the more fractures
epidemiology study.Data were prospectively collected over 5 years (August 2010-August 2015) at our regional trauma and spine unit, regardless of whether the rider was performing the sport competitively or recreationally.During the study period, spine-related injuries were identified for 174 patients (age range, 6-75 years) who were directly referred to our department following recreational or competitive motocross, with most injuries being sustained within the early spring and summer months, representing (...) the start of the motocross season. A significant number of injuries were in males (n = 203, 94%), with the majority of injuries occurring within the 21- to 30-year-old age group. A total of 116 (54%) injuries required operative treatment. The most common spinal injury was thoracolumbar burst fracture (n = 95), followed by chance fractures (n = 26).This data series emphasizes the prevalence and devastation of motocross-related spinal injuries in the United Kingdom and may serve in administering sanctions
- 75 years and older Clinically diagnosed thoracolumbar and/or lumbo-sacro-pelvic deformity as defined by the SRS/Schwab classification systems as Cobb angle of 25° or greater Able to ambulate without assistance and stand without assistance with their eyes open for a minimum of 10 seconds Able and willing to attend and perform the activities described in the informed consent within the boundaries of the timelines set forth for pre-, and post-treatment follow-up Exclusion Criteria: History of prior (...) attempt at fusion (successful or not) at the indicated levels, (history of one level fusion is not an exclusion) Major lower extremity surgery or previous injury that may affect gait (a successful total joint replacement is not an exclusion) BMI higher than 35 Neurological disorder, diabetic neuropathy or other disease that impairs the patient's ability to ambulate or stand without assistance Major trauma to the pelvis Pregnant or wishing to become pregnant during the study Contacts and Locations Go
Inclusion Criteria: Any adult patient 18 years of age and older who is undergoing surgery for a lumbar spine problem. Common diagnoses in this category would include lumbar disc herniations, spinal stenosis, and spondylolisthesis, but this is not an exhaustive list. Exclusion Criteria: Patients with comorbidities excluding use of proposed injection. Patients with major head trauma such that they cannot provide consent or describe their post-operative pain. Patients with other surgical treatment during (...) with a fracture, tumor, or infection as their primary diagnosis. Patients undergoing a deformity correction. Patients with surgeries extending more than 4 levels, with surgeries that extend to the pelvis, or with surgeries that cross the thoracolumbar junction. Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. Please refer to this study
for degenerative pathologies (stenosis, spondylolisthesis, degenerative disc disease, recurrent disc herniation), infections, fractures, trauma, or tumors. Criteria Inclusion Criteria Informed consent Thoracolumbar pedicle screw placement Indication for surgery: Degenerative pathologies (stenosis, spondylolisthesis, degenerative disc disease, recurrent disc herniation), infections, tumors, fractures, trauma Age ≥ 18 Exclusion Criteria Deformity surgery >5 index levels Contacts and Locations Go to Information (...) Information provided by (Responsible Party): Marc Schröder, Bergman Clinics Study Details Study Description Go to Brief Summary: In a multinational prospective study, preoperative, intraoperative, perioperative and follow-up data on patients receiving thoracolumbar pedicle screw placement for degenerative disease or infections or tumors will be collected. The three arms consist of robot-guided (RG), navigated (NV), or freehand (FH) screw insertion. Condition or disease Intervention/treatment Degenerative
, nerve root compression symptoms, may be associated with urinary dysfunction, conservative treatment is invalid or gradually increased; Exclusion Criteria: Cervical ligamentous ossification, cervical trauma, cervical cancer, cervical tuberculosis and other inflammatory diseases; accompanied by thoracolumbar spine and other spine parts of the disease affect the clinical symptoms of patients; associated with amyotrophic lateral sclerosis and other motor neuron diseases and other neurological diseases
, transcutaneous spinal cord stimulation (termed here transspinal stimulation) in people with SCI can evoke rhythmic leg muscle activity when gravity is eliminated. A fundamental knowledge gap still exists on induction of functional neuroplasticity and recovery of leg motor function after repetitive thoracolumbar transspinal stimulation during body weight supported (BWS) assisted stepping in people with SCI. The central working hypothesis in this study is that transspinal stimulation delivered during BWS (...) combined with non-invasive thoracolumbar transspinal stimulation at 0.3 or at 30 Hz. Masking: None (Open Label) Primary Purpose: Treatment Official Title: Activity-Dependent Transspinal Stimulation for Recovery of Walking Ability After Spinal Cord Injury Actual Study Start Date : August 1, 2018 Estimated Primary Completion Date : May 30, 2021 Estimated Study Completion Date : May 30, 2021 Resource links provided by the National Library of Medicine related topics: related topics: resources: Arms