Charcot's Spine with Neurological Deficit: Computed Tomography as an Aid to Treatment

Neurosurgery ◽  
1986 ◽  
Vol 19 (1) ◽  
pp. 108-110 ◽  
Author(s):  
Richard B. Raynor
Keyword(s):  
Computed Tomography ◽  
Lumbar Spine ◽  
High Risk ◽  
Neurological Deficit ◽  
Film Studies ◽  
Nonoperative Treatment ◽  
Degenerative Changes ◽  
X Ray ◽  
Computed Tomographic

Abstract A patient with Charcot's disease of the lumbar spine presented with weakness of one extremity. Myelographic and x-ray film studies indicated stenosis and compression due to degenerative changes. Although decompression and fusion were considered, computed tomographic scans indicated the wide extent and location of the destructive changes. Nonoperative treatment was elected because of the high risk of fusion failure and instability.

Percutaneous Discectomy: An Anatomical Study

Neurosurgery ◽  
1985 ◽  
Vol 16 (2) ◽  
pp. 141-147 ◽  
Author(s):  
Steven L. Kanter ◽  
William A. Friedman
Keyword(s):  
Computed Tomography ◽  
Lumbar Spine ◽  
Vascular Injury ◽  
Anatomical Study ◽  
Intervertebral Discs ◽  
Viable Alternative ◽  
Percutaneous Discectomy ◽  
Computed Tomographic ◽  
Anatomical Analysis ◽  
Computed Tomographic Scan

Abstract Percutaneous discectomy is a viable alternative in the treatment of herniated intervertebral discs of the lumbar spine. Anatomical analysis of the retroperitoneal surgical path utilizing computed tomography suggests that the risk of vascular injury is negligible at the L-4, L-5 level, but substantial at the L-5, S-1 level. In addition, one-third of patients otherwise suitable for percutaneous discectomy have segments of bowel obstructing the surgical path. Obtaining an abdominal computed tomographic scan with the patient in the surgical position seems to be a valuable screening technique in the evaluation of candidates for this procedure.

scholarly journals Dual-Energy X-Ray Absorptiometry vs Computed Tomography: Comparison of Bone Mineral Density Measurements in Predicting Postoperative Spinal Fusion Outcomes

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Awais Vance ◽  
Alexander Mazal ◽  
Salah G Aoun ◽  
Najib El Tecle ◽  
Matthew Thomas Davies ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Lumbar Fusion ◽  
Dual Energy ◽  
Mineral Density ◽  
Hounsfield Units ◽  
X Ray ◽  
Hardware Failure ◽  
Increased Risk

Abstract INTRODUCTION Diminished bone mineral density (BMD) places patients at increased risk for complications from lumbar fusion procedures. Dual-energy X-Ray absorptiometry (DEXA) scanners have been used as the gold standard in measuring BMD. More recently, various studies have suggested that Hounsfield unit measurements from computed tomography (CT) scans may be more accurate. METHODS After obtaining IRB approval, we retrospectively reviewed all patients aged 18 and older who underwent lumbar fusion procedures between 01/01/2010 and 12/31/2016 at our institution. We used linear regression to assess for a correlation between CT Hounsfield units and DEXA t scores. Student's t-test was used to compare CT Hounsfield units, lumbar spine t score and hip t scores for patients with and without pseudoarthrosis as well as those with and without hardware failure. RESULTS A total of 167 patients with lumbar fusion procedures met inclusion criteria. Ages ranged 24 to 88 yr old with a mean of 64. Using linear regression there was no correlation between CT Hounsfield units and Dexa T scores. There was no difference between the groups with respect to CT Hounsfield units or DEXA T scores when comparing patients with and without pseudoarthrosis and when comparing patients with or without hardware failure. CONCLUSION Diminished BMD is an important factor to consider when contemplating lumbar spine fusion procedures as this has been associated with increased risk of hardware failure or pseudoarthrosis. Traditionally DEXA scans and more recently CT Hounsfield units have used to screen patients for decreased BMD, however, in this relatively large retrospective series we found that neither correlate well with complications from lumbar spine fusion procedures. CT and DEXA scans may not be as reliable as once thought in assessing BMD.

Effect of spinal degenerative changes on volumetric bone mineral density of the central skeleton as measured by quantitative computed tomography

2005 ◽  
Vol 46 (3) ◽  
pp. 269-275 ◽  
Author(s):  
G. Guglielmi ◽  
I. Floriani ◽  
V. Torri ◽  
J. Li ◽  
C. van Kuijk ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Bone Mineral ◽  
Vertebral Fractures ◽  
Quantitative Computed Tomography ◽  
Degenerative Changes ◽  
Volumetric Bone Mineral Density ◽  
Mineral Density ◽  
The Impact

Purpose: To evaluate the impact of degenerative changes due to osteoarthritis (OA) at the spine on volumetric bone mineral density (BMD) as measured by volumetric quantitative computed tomography (vQCT). Material and Methods: Eighty‐four elderly women (mean age 73±6 years), comprising 33 with vertebral fractures assessed by radiographs and 51 without vertebral fractures, were studied. Trabecular, cortical, and integral BMD were examined at the spine and hip using a helical CT scanner and were compared to dual X‐ray absorptiometry (DXA) measurements at the same sites. OA changes visible on the radiographs were categorized into two grades according to severity. Differences in BMD measures obtained in the two groups of patients defined by OA grade using the described radiologic methods were compared using analysis of variance. Standardized difference (effect sizes) was also compared between radiologic methods. Results: Spinal trabecular BMD did not differ significantly between OA grade 0 and OA grade 1. Spinal cortical and integral BMD measures showed statistically significant differences, as did the lumbar spine DXA BMD measurement (13%, P = 0.02). The QCT measurements at the hip were also higher in OA 1 subjects. Femoral trabecular BMD was 13–15% higher in OA grade 1 subjects than in OA grade 0 subjects. The cortical BMD measures in the CT_TOT_FEM and CT_TROCH ROI's were also higher in the OA 1 subjects. The integral QCT BMD measures in the hip showed difference between grades OA 1 and 0. The DXA measurements in the neck and trochanter ROI's showed smaller differences (9 and 11%, respectively). There were no statistically significant differences in bone size. Conclusion: There is no evidence supporting that trabecular BMD measurements by QCT are influenced by OA. Instead, degenerative changes have an effect on both cortical and integral QCT, and on DXA at the lumbar spine and the hip. For subjects with established OA, assessment of BMD by volumetric QCT may be suggested.

scholarly journals Radiological changes among artistic gymnasts in Gauteng Province

2014 ◽  
Vol 26 (3) ◽  
pp. 69
Author(s):  
Adele Geldenhuys-Koolen ◽  
Demitri Constantinou ◽  
Yoga Coopoo
Keyword(s):  
Lumbar Spine ◽  
Primary Objective ◽  
Degenerative Changes ◽  
Measuring Instruments ◽  
Gauteng Province ◽  
X Ray ◽  
Lower Back ◽  
Self Reports ◽  
Radiological Changes ◽  
Female Gymnasts

Background. The skeletal immaturity of competitive female gymnasts allows for a unique physiological predisposition to injuries as a result of the spine, limbs, ankles and wrists still growing. Studies have shown that lower back (spinal) injuries account for approximately 12% of injuries in female gymnasts.Objectives. The primary objective of the study was to determine the prevalence of radiological changes in female artistic gymnasts in South Africa. A further objective was to determine whether these radiological changes were associated with symptoms and with the amount of time spent training.Methods. A sample of 40 female artistic gymnasts with a mean of age 15.2 years (range 10 - 31) was included in the study. Thirty-one were active gymnasts and nine were retired at the time of the current study. Measuring instruments included questionnaires and X-rays.Results. X-ray analysis of symptomatic versus asymptomatic gymnasts showed no significant differences. Of the 18 gymnasts training <25 h/week, 13 (72%) had degenerative changes detectable by X-ray. Of the 22 gymnasts training >25 h/week, 15 (68%) had degenerative changes detected by X-ray. Radiological changes were higher than those in other studies.Conclusion. The prevalence of radiological changes was higher than international norms, however there was little difference between symptomatic and asymptomatic gymnasts. Patient self-reports of symptoms had little value in diagnosing change in the lumbar spine. Training duration affected the prevalence of changes in the lumbar spine and could be related to conditioning and experience.

Management of Fractures of the Thoracolumbar and Lumbar Spine

Neurosurgery ◽  
1981 ◽  
Vol 8 (5) ◽  
pp. 555-561 ◽  
Author(s):  
Quentin J. Durward ◽  
Joseph F. Schweigel ◽  
Philip Harrison
Keyword(s):  
Lumbar Spine ◽  
Neurological Deficit ◽  
Spinal Injury ◽  
Ct Scanning ◽  
Fracture Dislocation ◽  
Poor Correlation ◽  
Ct Scanner ◽  
Injury Site ◽  
Computed Tomographic ◽  
Bone Fragments

Abstract Eleven cases of fracture or fracture/dislocation of the thoracolumbar or lumbar spine were studied to determine the effectiveness of three methods of management of the injuries. Ten of the patients had a neurological deficit as well as a spinal injury. All cases were studied by computed tomographic (CT) scanning of the injury site before and after treatment. CT scanning was found to be superior to linear tomography in determining the degree of canal compromise by bone at the injury site. Eight patients underwent operation, with the aims of achieving spinal stability in unstable injuries and of decompressing neural structures. These 8 patients had received Harrington distraction instrumentation (HDI) as an initial procedure. In those patients with fracture/dislocations from flexion-rotation injuries and canal compromise resulting from bony malalignment, reduction of the fracture/dislocation by HDI resulted in stabilization of the spine and increase of the open canal area at the injury site. However, in those patients with canal compromise resulting from bursting fractures with retropulsed bone fragments, HDI did not reduce the bone fragments. Removal of the anterior vertebral body and the bone fragments. however, did result in significant improvement of the canal dimensions. A poor correlation was found between the degree of canal compromise as measured by the CT scanner and the resulting neurological deficit. Reasons for this are presented. Six of the 10 neurologically compromised patients, including 2 patients with stable bursting injuries and retropulsed bone fragments treated conservatively, had improved one grade on Frankel's classification by 3 months after injury. The rate and degree of recovery were not related to the degree of canal decompression achieved at operation.

INDICATORS OF DOUBLE X-RAY ABSORPTION METER, MINERAL METABOLISM AND BONE METABOLISM IN MEN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE OF VARIOUS RISK OF EXCERNATIONS

2020 ◽  
pp. 108-112
Author(s):  
Schegortsova Y.Y. ◽  
Pavlenko V.I.
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Lumbar Spine ◽  
High Risk ◽  
Chronic Obstructive ◽  
Phosphorus Metabolism ◽  
Obstructive Pulmonary Disease ◽  
X Ray ◽  
Calcium Phosphorus ◽  
Group 2 ◽  
Exacerbation Of Copd

Aim. assesses bone density (BD), calcium - phosphorus metabolism and bone metabolism in male patients with chronic obstructive pulmonary disease (COPD) of different risk of exacerbation. Materials and methods. Men with COPD GOLD II-III aged 50 to 65 years were examined: group 1 (n = 43) - low risk of exacerbation of COPD, group 2 (n = 62) - high risk of exacerbation of COPD. BD was determined by double X-ray absorptiometry in the area of the lumbar spine in the area L1-L4 and the femoral neck (FN). The content of C-terminal telopeptide (CTX) in blood serum was determined by enzyme immunoassay. The state of calcium-phosphorus metabolism was assessed by the level of concentration of total calcium (Ca), inorganic phosphorus (P) in the blood serum, product Ca × P. Results. Decreased BD in the lumbar spine in the L1-L4 zone and FN among men with COPD was found in 66.7% of cases, of which 30 (42.8%) had osteopenia, 40 (57.1%) had osteoporosis (OP). 28 (26.6%) people had hypocalcemia. In 66 (62.9%) subjects, the CTX value was higher than the threshold value. In group 2 patients, the incidence of OP, hypocalcemia, and increased CTX was higher. A reliable inverse correlation was established between the moderate strength of the frequency of exacerbations with the T-criterion in the L1-L4 zone, FN, BMD L1-L4 and BMD FN. Frequent exacerbations of COPD increase the risks and chances of developing OP, hypocalcemia, and increased CTX. Conclusion. The results obtained indicate a high incidence of decreased BD, impaired calcium-phosphorus metabolism and an increase in the marker of bone resorption CTX among men with COPD, with a predominance in those with a high risk of exacerbation of the disease.

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