Intervertebral Disc Disease
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Diaphragm and Intercostal Muscles
Diaphragm and intercostal muscles Dr. Heba Kalbouneh Associate Professor of Anatomy and Histology Skeletal System Adult Human contains 206 Bones 2 parts: Axial skeleton (axis): Skull, Vertebral column, Thoracic cage Appendicular skeleton: Bones of upper limb Bones of lower limb Dr. Heba Kalbouneh Structure of Typical Vertebra Body Vertebral foramen Pedicle Transverse process Spinous process Lamina Dr. Heba Kalbouneh Superior articular process Intervertebral disc Dr. Heba Inferior articular process Dr. Heba Facet joints are between the superior articular process of one vertebra and the inferior articular process of the vertebra directly above it Inferior articular process Superior articular process Dr. Heba Kalbouneh Atypical Vertebrae Atlas (1st cervical vertebra) Axis (2nd cervical vertebra) Dr. Heba Atlas (1st cervical vertebra) Communicates: sup: skull (atlanto-occipital joint) inf: axis (atlanto-axial joint) Atlas (1st cervical vertebra) Characteristics: 1. no body 2. no spinous process 3. ant. & post. arches 4. 2 lateral masses 5. 2 transverse foramina Typical cervical vertebra Specific to the cervical vertebra is the transverse foramen (foramen transversarium). is an opening on each of the transverse processes which gives passage to the vertebral artery Thoracic Cage - Sternum (G, sternon= chest bone) -12 pairs of ribs & costal cartilages -12 thoracic vertebrae Manubrium Body Sternum: Flat bone 3 parts: Xiphoid process Dr. Heba Kalbouneh Dr. Heba Kalbouneh The external intercostal muscle forms the most superficial layer. Its fibers are directed downward and forward from the inferior border of the rib above to the superior border of the rib below The muscle extends forward to the costal cartilage where it is replaced by an aponeurosis, the anterior (external) intercostal membrane Dr. -
Lumbar Spine Schmorl's Nodes; Prevalence in Adults with Back Pain, and Their Relation to Vertebral Endplate Degeneration Israa Mohammed Sadiq
Sadiq Egyptian Journal of Radiology and Nuclear Medicine (2019) 50:65 Egyptian Journal of Radiology https://doi.org/10.1186/s43055-019-0069-9 and Nuclear Medicine RESEARCH Open Access Lumbar spine Schmorl's nodes; prevalence in adults with back pain, and their relation to vertebral endplate degeneration Israa Mohammed Sadiq Abstract Background: In 1927, Schmorl described a focal herniation of disc material into the adjacent vertebral body through a defect in the endplate, named as Schmorl’s node (SN). The aim of the study is to reveal the prevalence and distribution of Schmorl’s nodes (SNs) in the lumbar spine and their relation to disc degeneration disease in Kirkuk city population. Results: A cross-sectional analytic study was done for 324 adults (206 females and 118 males) with lower back pain evaluated as physician requests by lumbosacral MRI at the Azadi Teaching Hospital, Kirkuk city, Iraq. The demographic criteria of the study sample were 20–71 years old, 56–120 kg weight, and 150–181 cm height. SNs were seen in 72 patients (22%). Males were affected significantly more than the females (28.8% vs. 18.8%, P = 0.03). SNs were most significantly affecting older age groups. L1–L2 was the most affected disc level (23.6%) and the least was L5–S1 (8.3%). There was neither a significant relationship between SN and different disc degeneration scores (P = 0.76) nor with disc herniation (P = 0.62, OR = 1.4), but there was a significant relation (P = 0.00001, OR = 7.9) with MC. Conclusion: SN is a frequent finding in adults’ lumbar spine MRI, especially in males; it is related to vertebral endplate bony pathology rather than discal pathology. -
How to Perform a Transrectal Ultrasound Examination of the Lumbosacral and Sacroiliac Joints
DIAGNOSTIC IMAGING How to Perform a Transrectal Ultrasound Examination of the Lumbosacral and Sacroiliac Joints Erik H.J. Bergman, DVM, Diplomate ECAR, Associate Member LA-ECVDI*; Sarah M. Puchalski, DVM, Diplomate ACVR; and Jean-Marie Denoix, DVM, PhD, Agre´ge´, Associate Member LA-ECVDI Authors’ addresses: Lingehoeve Veldstraat 3 Lienden 4033 AK, The Netherlands (Bergman); Uni- versity of California, Davis, One Shields Avenue, School of Veterinary Medicine, Davis, CA 95616 (Puchalski); E´ cole Nationale Ve´te´rinaire d’Alfort, 7 Avenue du Ge´ne´ral de Gaulle, 94700 Maisons- Alfort, France (Denoix); e-mail: [email protected]. *Corresponding and presenting author. © 2013 AAEP. 1. Introduction have allowed for identification of these structures 5 There is increasing interest in pathology of the and the inter-transverse joints. These authors urge lumbosacral and sacroiliac joints giving rise to stiff- caution in the interpretation of lesions identified on ness and/or lameness and decreased performance radiography in the absence of other diagnostic im- in equine sports medicine.1–3 Pain arising from aging and clinical examination. Nuclear scintigra- these regions can be problematic alone or in con- phy is an important component of work-up for junction with lameness arising from other sites sacroiliac region pain, but limitations exist. Sev- 9,10 (thoracolumbar spine, hind limbs, or forelimbs).4 eral reports exist detailing the anatomy and tech- Localization of pain to this region is critically impor- nique findings in normal horses11,12 and findings in tant through clinical assessment, diagnostic anes- lame horses.13 Patient motion, camera positioning, thesia, and imaging. and muscle asymmetry can cause errors in interpre- In general, diagnostic imaging of the axial skele- tation. -
Artificial Intervertebral Disc: Lumbar Spine Page 1 of 22
Artificial Intervertebral Disc: Lumbar Spine Page 1 of 22 Medical Policy An Independent licensee of the Blue Cross Blue Shield Association Title: Artificial Intervertebral Disc: Lumbar Spine Related Policy: . Artificial Intervertebral Disc: Cervical Spine Professional Institutional Original Effective Date: August 9, 2005 Original Effective Date: August 9, 2005 Revision Date(s): June 14, 2006; Revision Date(s): June 14, 2006; January 1, 2007; July 24, 2007; January 1, 2007; July 24, 2007; September 25 2007; February 22, 2010; September 25 2007; February 22, 2010; March 10, 2011; March 8, 2013; March 10 2011; March 8, 2013; June 23, 2015; August 4, 2016; June 23, 2015; August 4, 2016; May 23, 2018; July 17, 2019; May 23, 2018; July 17, 2019; August 21, 2020; July 1, 2021 August 21, 2020; July 1, 2021 Current Effective Date: September 23, 2008 Current Effective Date: September 23, 2008 State and Federal mandates and health plan member contract language, including specific provisions/exclusions, take precedence over Medical Policy and must be considered first in determining eligibility for coverage. To verify a member's benefits, contact Blue Cross and Blue Shield of Kansas Customer Service. The BCBSKS Medical Policies contained herein are for informational purposes and apply only to members who have health insurance through BCBSKS or who are covered by a self-insured group plan administered by BCBSKS. Medical Policy for FEP members is subject to FEP medical policy which may differ from BCBSKS Medical Policy. The medical policies do not constitute medical advice or medical care. Treating health care providers are independent contractors and are neither employees nor agents of Blue Cross and Blue Shield of Kansas and are solely responsible for diagnosis, treatment and medical advice. -
The Effect of Training on Lumbar Spine Posture and Intervertebral Disc Degeneration in Active-Duty Marines
The Effect of Training on Lumbar Spine Posture and Intervertebral Disc Degeneration in Active-Duty Marines Ana E. Rodriguez-Soto, PhDc, David B. Berry, MScc, Rebecca Jaworski, PhDd,1, Andrew Jensen, MScd,g,2, Christine B. Chung, MDe,f, Brenda Niederberger, MAd,g, Aziza Qadirh, Karen R. Kelly, PT, PhDd,g , Samuel R. Ward, PT, PhDa,b,c aDepartments of Radiology, bOrthopaedic Surgery, and cBioengineering University of California, San Diego 9500 Gilman Drive (0610), La Jolla, CA 92093 dDepartment of Warfighter Performance, Naval Health Research Center 140 Sylvester Road, San Diego, CA 92106-3521 eDepartment of Radiology, Veteran Administration San Diego Healthcare System 3350 La Jolla Village Dr., San Diego, CA 92161 fDepartment of Radiology, University of California, San Diego Medical Center 408 Dickinson Street, San Diego, CA 92103-8226 gSchool of Exercise and Nutritional Sciences, San Diego State University ENS Building room 351, 5500 Campanile, San Diego, CA 92182-7251 hVital Imaging Center 5395 Ruffin Rd Suite 100, San Diego CA 92123 Ana Elvira Rodriguez-Soto, PhD E-mail: [email protected] David Barnes Berry, MS E-mail: [email protected] Rebecca Jaworski, PhD E-mail: [email protected] Present Address: 1Office of the Naval Inspector General 1254 9th St. SE, Washington Navy Yard, DC 90374-5006 Andrew Jensen, MS E-mail: [email protected] Present address: 2Department of Biological Sciences, University of Southern California PED 107 3560 Watt Way, Los Angeles, CA 90089-0652 Christine B. Chung, MD E-mail: [email protected] Brenda Niederberger, MA E-mail: [email protected] Aziza Qadir E-mail: [email protected] Karen R. -
Redefining Lumbar Spinal Stenosis As a Developmental Syndrome
CLINICAL ARTICLE J Neurosurg Spine 29:654–660, 2018 Redefining lumbar spinal stenosis as a developmental syndrome: an MRI-based multivariate analysis of findings in 709 patients throughout the 16- to 82-year age spectrum Sameer Kitab, MD,1 Bryan S. Lee, MD,2,3 and Edward C. Benzel, MD2,3 1Scientific Council of Orthopedics, Baghdad, Iraq; 2Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic; and 3Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio OBJECTIVE Using an imaging-based prospective comparative study of 709 eligible patients that was designed to as- sess lumbar spinal stenosis (LSS) in the ages between 16 and 82 years, the authors aimed to determine whether they could formulate radiological structural differences between the developmental and degenerative types of LSS. METHODS MRI structural changes were prospectively reviewed from 2 age cohorts of patients: those who presented clinically before the age of 60 years and those who presented at 60 years or older. Categorical degeneration variables at L1–S1 segments were compared. A multivariate comparative analysis of global radiographic degenerative variables and spinal dimensions was conducted in both cohorts. The age at presentation was correlated as a covariable. RESULTS A multivariate analysis demonstrated no significant between-groups differences in spinal canal dimensions and stenosis grades in any segments after age was adjusted for. There were no significant variances between the 2 cohorts in global degenerative variables, except at the L4–5 and L5–S1 segments, but with only small effect sizes. Age- related degeneration was found in the upper lumbar segments (L1–4) more than the lower lumbar segments (L4–S1). -
Posterior Longitudinal Ligament Status in Cervical Spine Bilateral Facet Dislocations
Thomas Jefferson University Jefferson Digital Commons Department of Orthopaedic Surgery Faculty Papers Department of Orthopaedic Surgery November 2005 Posterior longitudinal ligament status in cervical spine bilateral facet dislocations John A. Carrino Harvard Medical School & Brigham and Women's Hospital Geoffrey L. Manton Thomas Jefferson University Hospital William B. Morrison Thomas Jefferson University Hospital Alex R. Vaccaro Thomas Jefferson University Hospital and The Rothman Institute Mark E. Schweitzer New York University & Hospital for Joint Diseases Follow this and additional works at: https://jdc.jefferson.edu/orthofp Part of the Orthopedics Commons LetSee next us page know for additional how authors access to this document benefits ouy Recommended Citation Carrino, John A.; Manton, Geoffrey L.; Morrison, William B.; Vaccaro, Alex R.; Schweitzer, Mark E.; and Flanders, Adam E., "Posterior longitudinal ligament status in cervical spine bilateral facet dislocations" (2005). Department of Orthopaedic Surgery Faculty Papers. Paper 3. https://jdc.jefferson.edu/orthofp/3 This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in Department of Orthopaedic Surgery Faculty Papers by an authorized administrator of the Jefferson Digital Commons. For more information, please contact: [email protected]. -
The Effectiveness of Lumbar Spinal Perineural Analgesia (LSPA) for Various Causes of Low Back Ache
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 19, Issue 6 Ser.19 (June. 2020), PP 08-13 www.iosrjournals.org The Effectiveness of Lumbar Spinal Perineural Analgesia (LSPA) For Various Causes of Low Back Ache Dr. Biju Bhadran MS MCh1, Dr. Arvind K R MS MCh2, Dr. Krishnakumar MS MCh3, Dr. Harrison MS MCh4, Dr. Raghunath MCh5 1Department of Neurosurgery, Govt. TD Medical College, Alappuzha, Kerala, India 2Department of Neurosurgery, Govt. TD Medical College, Alappuzha, Kerala, India 3Department of Neurosurgery, Govt. TD Medical College, Alappuzha, Kerala, India 4Department of Neurosurgery, Govt. TD Medical College, Alappuzha, Kerala, India 5Department of Neurosurgery, Govt. TD Medical College, Alappuzha, Kerala, India Abstract: Background: Back pain is a common medical problem and predominant cause for medical consultations. The concept of lumbar spinal perineural analgesia (LSPA) is to achieve reduction of pain and desensitization of irritated neural structures and not complete analgesia or paralysis of lumbar spinal nerves. This article is intended to study the effectiveness of lumbar spinal perineural analgesia (LSPA) for various causes of low back ache on the basis of degree of pain relief following the procedure. Materials and Methods: This was a prospective study comprising of 50 patients who had undergone appropriate investigations before assessment for eligibility, confirming the existence of lumbar disc disease and these selected patients underwent lumbar perineural analgesia for different causes of low back ache not relieved with other conservative modalities of treatment. Pre procedure and post procedure, the severity of pain level was assessed with standard verbal rating scale (VRS), with a score of 1 = no pain, 2 = mild pain, 3 = moderate pain, 4 = severe pain and 5 = intolerable pain. -
Sacroiliac Joint Dysfunction a Case Study
NOR200188.qxd 3/8/11 9:53 PM Page 126 Sacroiliac Joint Dysfunction A Case Study CPT William Murray Pain is a widespread issue in the United States. Nine of physical therapist. She was evaluated and her treatment 10 Americans regularly suffer from pain, and nearly every consisted of a transcutaneous electrical nerve stimula- person will experience low back pain at one point in their lives. tion unit while in the PT clinic, aqua therapy, and ice Undertreated or unrelieved pain costs more than and heat application. $60 billion a year from decreased productivity, lost income, After several weeks, Ms. T returned to the primary care and medical expenses. The ability to diagnose and provide ap- provider and informed her that the pain has not decreased and “feels like that it is getting worse.” She also informed propriate medical treatment is imperative. This case study ex- the provider that she was having difficulty sleeping and amines a 23-year-old Active Duty woman who is preparing to constantly feeling tired secondary to pain. Throughout the be involuntarily released from military duty for an easily cor- next several months, the primary care provider tried nu- rectable medical condition. She has complained of chronic low merous medication trials with no relief for the patient. Ms. back pain that radiates into her hip and down her leg since ex- T gives a history of being prescribed numerous medica- periencing a work-related injury. She has been seen by numer- tions within several drug classifications. She stated vari- ous providers for the previous 11 months before being referred ous side effects that are related to the medications and to the chronic pain clinic. -
Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy
Y Lumbar Disc Herniation with Radiculopathy | NASS Clinical Guidelines 1 G Evidence-Based Clinical Guidelines for Multidisciplinary ETHODOLO Spine Care M NE I DEL I U /G ON Diagnosis and Treatment of I NTRODUCT Lumbar Disc I Herniation with Radiculopathy NASS Evidence-Based Clinical Guidelines Committee D. Scott Kreiner, MD Paul Dougherty, II, DC Committee Chair, Natural History Chair Robert Fernand, MD Gary Ghiselli, MD Steven Hwang, MD Amgad S. Hanna, MD Diagnosis/Imaging Chair Tim Lamer, MD Anthony J. Lisi, DC John Easa, MD Daniel J. Mazanec, MD Medical/Interventional Treatment Chair Richard J. Meagher, MD Robert C. Nucci, MD Daniel K .Resnick, MD Rakesh D. Patel, MD Surgical Treatment Chair Jonathan N. Sembrano, MD Anil K. Sharma, MD Jamie Baisden, MD Jeffrey T. Summers, MD Shay Bess, MD Christopher K. Taleghani, MD Charles H. Cho, MD, MBA William L. Tontz, Jr., MD Michael J. DePalma, MD John F. Toton, MD This clinical guideline should not be construed as including all proper methods of care or excluding or other acceptable methods of care reason- ably directed to obtaining the same results. The ultimate judgment regarding any specific procedure or treatment is to be made by the physi- cian and patient in light of all circumstances presented by the patient and the needs and resources particular to the locality or institution. I NTRODUCT 2 Lumbar Disc Herniation with Radiculopathy | NASS Clinical Guidelines I ON Financial Statement This clinical guideline was developed and funded in its entirety by the North American Spine Society (NASS). All participating /G authors have disclosed potential conflicts of interest consistent with NASS’ disclosure policy. -
Utilization Management Policy Title: Lumbar Spine Surgeries
Medica Policy No. III-SUR.34 UTILIZATION MANAGEMENT POLICY TITLE: LUMBAR SPINE SURGERIES EFFECTIVE DATE: January 18, 2021 This policy was developed with input from specialists in orthopedic spine surgery and endorsed by the Medical Policy Committee. IMPORTANT INFORMATION – PLEASE READ BEFORE USING THIS POLICY These services may or may not be covered by all Medica plans. Please refer to the member’s plan document for specific coverage information. If there is a difference between this general information and the member’s plan document, the member’s plan document will be used to determine coverage. With respect to Medicare and Minnesota Health Care Programs, this policy will apply unless these programs require different coverage. Members may contact Medica Customer Service at the phone number listed on their member identification card to discuss their benefits more specifically. Providers with questions about this Medica utilization management policy may call the Medica Provider Service Center toll-free at 1-800-458-5512. Medica utilization management policies are not medical advice. Members should consult with appropriate health care providers to obtain needed medical advice, care and treatment. PURPOSE To promote consistency between Utilization Management reviewers by providing the criteria that determine medical necessity. BACKGROUND I. Prevalence / Incidence A. It is reported that the lifetime incidence of low back pain (LBP) in the general population within the United States is between 60% and 90%, with an annual incidence of 5%. According to a National Center for Health Statistics study (Patel, 2007), 14.3% of new patient visits to primary care physicians per year are for LBP. -
Radicular Pain Caused by Schmorl's Node: a Case Report
Rev Bras Anestesiol. 2018;68(3):322---324 REVISTA BRASILEIRA DE Publicação Oficial da Sociedade Brasileira de Anestesiologia ANESTESIOLOGIA www.sba.com.br CLINICAL INFORMATION Radicular pain caused by Schmorl’s node: a case report ∗ Saeyoung Kim , Seungwon Jang Kyungpook National University, School of Medicine, Department of Anesthesiology and Pain Medicine, Daegu, Republic of Korea Received 29 September 2016; accepted 19 July 2017 Available online 30 August 2017 KEYWORDS Abstract Schmorl’s node a focal herniation of intervertebral disc through the end plate into the vertebral body. Most of the established Schmorl’s nodes are quiescent. However, disc herniation Epidural analgesia; into the vertebral marrow can cause low back pain by irritating a nociceptive system. Schmorl’s Low back pain; Sciatica; node induced radicular pain is a very rare condition. Some cases of Schmorl’s node which Steroids generated low back pain or radicular pain were treated by surgical methods. In this article, authors reported a rare case of a patient with radicular pain cause by Schmorl’s node located at the inferior surface of the 5th lumbar spine. The radicular pain was alleviated by serial 5th lumbar transforaminal epidural blocks. Transforaminal epidural block is suggested as first conservative option to treat radicular pain due to herniation of intervertebral disc. Therefore, non-surgical treatment such as transforaminal epidural block can be considered a first treatment option for radicular pain caused by Schmorl’s node. © 2017 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by- nc-nd/4.0/).