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PubMedDate not supplied

Occult spinal dysraphism.

When spina bifida is associated with skin abnormalities such as dimples, sinus tracts hypertrichosis, or capillary hemangiomas, there is a high incidence of an occult intraspinal lesion such as epidermoid and dermoid tumours, lipomas, diastematomyelia, dural bands and tethered spinal cord. The present study consists of 50 patients with occult spinal dysraphism treated with the diagnosis of lipomeningomyelocoele (20), lumbosacral lipoma (15) and diastematomyelia (15). The clinical presentation varied from lipoma in the lumbosacral region, dermal sinus, cutaneous hemangioma and hypertrichosis. The age range varied from 2 months to 7 years with an average of 2 years. 40% patients had neurological deficit at the time of presentation which varied from lower limb weakness to bladder & bowel involvement. All patients underwent laminectomy of the lumbar and lumbo-sacral spine with excision of intraspinal lipoma, excision of bony or cartilaginous spur in diastematomyelia and detethering of the conus medullaris & cauda equina. No patient developed late neurological deficit.

Child↗

PubMed1980

Lumbosacral spinal evoked potentials in humans.

Evoked potentials in response to submaximal electrical stimuli to the peroneal or tibial nerves were recorded from the lumbosacral region in 18 normal subjects. Averaging of 128 responses from recording electrodes over spinous processes S1 to T11, with a reference electrode on the contralateral iliac crest, demonstrated potentials of 0.5 to 1.8 microV, with two well-defined negative peaks having latencies proportional to the distance between the stimulating and recording electrodes. The first peak originated from a traveling wave of depolarization in afferent fibers in the cauda equina, and the second peak originated in the spinal cord. F waves, H reflexes, microreflexes, and volume-conducted muscle responses did not contribute to these potentials.

Adolescent↗

PubMed1986

Relationship of lumbosacral nevocytic nevi to sun exposure in dysplastic nevus syndrome.

In 104 consecutive Caucasian patients who had histologically proved dysplastic nevi, the number and diameter of nevocytic nevi were determined in two equally sized contiguous rectangles in the lumbosacral region. The cephalad (superior) rectangle was in a relatively sun-exposed site, whereas the caudad (inferior) rectangle was in a relatively sun-protected site. Many of the nevocytic nevi identified in these rectangles had the clinical features of dysplastic nevi. Significantly, more nevi were found in the cephalad rectangle compared with the caudad rectangle. Men greater than or equal to 40 years of age had significantly larger nevi in the cephalad rectangle compared with the caudad rectangle. These data are consistent with the hypothesis that sunlight promotes development of more and larger nevocytic nevi in individuals afflicted with dysplastic nevus syndrome.

Adolescent↗

PubMed1996

Extra-acral calcifying aponeurotic fibroma: a distinctive case with 23-year follow-up.

Calcifying aponeurotic fibroma (CAF) is an unusual but well-characterized soft tissue neoplasm that typically involves the digits of children and frequently recurs locally. This report describes a case from the subcutis of the lumbosacral region. A 26-year-old man initially presented at age 3 and developed three recurrences over a 23-year period each at approximately 8-year intervals (ages 10, 18, and 26). The microscopic findings in all recurrences showed a lobulated, poorly circumscribed proliferation of dense fibrous tissue containing epithelioid-like fibroblasts, multinucleated cells, and islands of metaplastic chondroid differentiation with focal calcification. Despite origin from an unusual anatomic site, this case reported herein demonstrates the classical morphologic features and clinical history of CAF which showed little in the way of morphologic evolution despite 23 years of persistence. The clinical and histologic features helpful in distinguishing CAF from infantile fibromatosis and soft tissue chondroma are discussed.

Adult↗

PubMed2000

Primary spinal epidural mantle cell lymphoma: case report.

OBJECTIVE AND IMPORTANCE: Mantle cell lymphoma is a distinct clinicopathological type of non-Hodgkin's lymphoma that often presents at an advanced stage, with systemic spread. Spinal involvement is uncommon and generally occurs as part of advanced disease or generalized relapses. Primary spinal epidural lymphoma is a rare initial manifestation of non-Hodgkin's lymphoma, and mantle cell lymphoma with initial presentation in the spinal epidural space is extremely rare, having been previously reported in only two cases. CLINICAL PRESENTATION: We report a case of a 71-year-old man who presented with increasing weakness and numbness of the legs. Magnetic resonance imaging revealed a spinal epidural mass in the lumbosacral region. INTERVENTION: The patient underwent a partial L4 and L5-S1 laminectomy, with incomplete resection of the mass for spinal decompression and tissue diagnosis. Mantle cell lymphoma was diagnosed in the pathological examination. CONCLUSION: After radiotherapy, the disease recurred with a soft-tissue mass in the anterior maxillary area of the face. The patient underwent restaging and was treated with chemotherapy, with only a partial response. Mantle cell lymphoma with primary spinal epidural presentation is rare. This diagnosis can be established and other causes of spinal cord compression can be ruled out by obtaining tissue for proper histopathological examinations. Because of its aggressive behavior and poor prognosis, mantle cell lymphoma should be treated using a combined-modality approach.

Aged↗

PubMed1991

[A case of human tail].

A human tail is a rare anatomical curiosity. A case of a human tail associated with lipomyelomeningocele is reported. The made subject was born, by breech delivery, at the 39th-week with a 3,008 g body weight. He was admitted to our hospital because of the presence of a human tail and subcutaneous mass in the midline lumbosacral region. The tail was about 7.5 cm in length and 2 cm in diameter. It was elastic and covered by normal skin. No systemic anomaly was found. Spina bifida below L5 was revealed, and no bony shadow was found on the plain X-ray film. CT scan showed a low density area in the spinal canal between L3 and lower sacral region that extended into the tail through the spina bifida. MRI also revealed intraspinal long T2 mass which was attached to the spinal cord and extended into the tail. Myelogram indicated intradural extramedullary mass below the L3 level. Surgical treatment was performed on the 3rd month of life with a diagnosis of a human tail with lipomyelomeningocele. At surgery, the tail was found to consist mainly of lipomatous tissue which extended subcutaneously and entered the spinal canal through the spina bifida. The tail and subcutaneous lipomatous tissue were totally excised. The capsule of subcutaneous lipomatous tissue was followed circumferentially down into the spinal canal, and found to be transformed to arachnoid membrane. Intradural lipomatous tissue was excised piece by piece, leaving only a small remnant attached to the conus medullaris to preserve sacral nerve root function.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗

PubMed1982

[Immunofluorescent and morphologic studies in Bekhterev's disease (preliminary findings)].

Fourteen skin biopsies (taken from the lumbosacral region) of patients with Bekhterev's disease were studied. Some histological changes in the connective tissue of the skin were followed up. Deposited immunogenic matters in the skin structures and the presence of circulating (serum) autoantibodies were looked for by immunofluorescence. In seven patients--a normal histological skin picture was established. A light to moderate subepidermal edema was observed in the rest of the biopsies as well as a tendency to focal homogenization and fragmentation of the collagen fibres, hyperemia, dilation and thickening of some vascular walls in hypoderm. Little parivascular cellular infiltrations were also found, composed of lymphocytes, macrophages, fibroblasts and plasmocytes. Via immunofluorescence, gamma globulins deposited in the vascular basal membranes were established in two patients and in three patients--circulating antinuclear autoantibodies. Immunological mechanisms are admitted to also play a role in the pathogenesis of some clinical forms of Bekhterev's disease.

Autoantibodies↗

PubMed1980

Fine structure of the lumbosacral neural folds in the mouse embryo.

The neural folds in the lumbosacral region of the normal 8-day and 9-day mouse embryo were studied by means of transmission electron microscopy with and without lanthanum treatment. The cells showed an abundance of ribosomes, microtubules arranged parallel to the long axes of the cells, and microfilaments extending across the apices. At the luminal border junctional complexes were common, and an occasional midbody was seen stretching between adjacent cells nearing the end of telophase. In the 8-day embryos, gap junctional vesicles (annular nexuses) bounded by layered membranes and containing cytoplasm with ribosome-like material were commonly observed; at 9 days the vesicles were relatively rare. The lanthanum-treated material demonstrated that the tracer was able to pass through the subluminal junctional complexes and throughout the intercellular spaces. However, the space between the membranes of the gap junctional vesicles lacked lanthanum and thus apparently did not communicate with the intercellular space.

Animals↗

PubMed1985

A biomechanical model of the lumbosacral joint during lifting activities.

A biomechanical model of the lumbosacral region was constructed for the purpose of systematically studying the combined stresses and strains on the local ligaments, muscles and disc tissue during sagittal plane two-handed lifting. The model was validated in two ways. The first validation was a comparison of experimental study results with model predictions. In general predictions compared very reasonably with observed values of several authors with the exception of strain predictions on the articular ligaments. Second, a sensitivity analysis was performed over a wide range of lifting tasks. The predicted stress/strain values followed anticipated patterns and were of reasonable magnitudes. On the basis of the results of the sensitivity analysis it was concluded that typical lifting tasks can lead to excessive disc compressive forces, muscle moment generation requirements, and possibly lumbodorsal fascia strains. Conversely, annulus rupture of a healthy disc due to overstrain appears very unlikely.

Biomechanical Phenomena↗

PubMed1994

Anatomy of the posterior approach to the lumbar plexus block.

The purpose of this study was to describe the relation of the lumbar plexus with the psoas major and with the superficial and deep landmarks close to it. Four cadavers were dissected and 22 computed tomography files of the lumbosacral region studied. Cadaver dissections demonstrated that the lumbar plexus, at the level of L5, is within the substance of the psoas major muscle rather than between this muscle and the quadratus lumborum. The femoral nerve lies between the lateral femoral cutaneous and obturator nerves. However, while the lateral femoral cutaneous nerve is in the same fascial plane as the femoral nerve, the obturator nerve can be found in the same plane as the two other nerves or in its own muscular fold. Radiological data provided the following measurements: the femoral nerve is at a depth of 9.01 +/- 2.43 cm; the psoas major medial border is at 2.73 +/- 0.64 cm from the median sagittal plane; and its lateral border is at 6.41 +/- 1.61 cm from the same plane. It is concluded that the lumbar plexus is within the psoas major, that the obturator nerve localization within the psoas major varies and that computed tomography data define precisely the relationship of the lumbar plexus with superficial and deep landmarks.

Adipose Tissue↗

PubMed1975

Electromyography in paraspinal muscles following surgery for root compression.

The paraspinal muscles were examined by electromyography (EMG) in 20 patients who had undergone laminectomy for root compression in the lumbosacral region. Cases were carefully selected to include only those in which there was no evidence of recurrent radiculopathy. The precise anatomic sites having electromyographic (EMG) abnormalities (fibrillation potentials and positive sharp waves) were determined. These data were obtained to determine if EMG of paraspinal muscles following laminectomy is useful in patients with a suspected recurrence. EMG was done 1 cm and 3 cm lateral from the midline at each vertebral level from L3 through S2. The interval between surgery and EMG ranged from 3-1/2 to 41 months. Seventeen of the 20 cases showed EMG abnormalities; and of these, 15 were abnormal at three or more vertebral levels and 13 at both 1 cm and 3 cm from the midline. It was shown that patients who have undergone laminectomy for root compression may demonstrate EMG changes in the paraspinal muscles for periods of up to 41 months postoperatively even without recurrent radiculopathy. The abnormalities are usually present at both 1 and 3 cm lateral from the midline and at multiple vertebral levels.

Adult↗

PubMed1999

Transcutaneous electrical nerve stimulation: nonparallel antinociceptive effects on chronic clinical pain and acute experimental pain.

OBJECTIVE: To investigate to what extent a single 60-minute session of transcutaneous electrical nerve stimulation (TENS) would modify chronic clinical pain, acute experimental pain, and the flexion reflex evoked in chronic low back pain patients. STUDY DESIGN: Thirty young subjects with chronic low back pain were randomly allocated to two groups, receiving either TENS or placebo stimulation to the lumbosacral region for 60 minutes. The flexion reflex was elicited by an electrical stimulation applied to the subject's right sole and recorded electromyographically from the biceps femoris and the tibialis anterior muscles. MAIN OUTCOME MEASURES: Subjective sensation of low back pain and the electrically induced pain were measured by two separate visual analog scales, termed VAS(LBP) and VAS(FR), respectively. Data obtained before, during, and 60 minutes after TENS and placebo stimulations were analyzed using repeated measures ANOVA. RESULTS: The VAS(LBP) score was significantly reduced to 63.1% of the prestimulation value after TENS (p<.001), but the reduction was negligible after placebo stimulation (to 96.7%, p = .786). In contrast, no significant change was found in the VASFR score (p = .666) and the flexion reflex area (p = .062) during and after stimulation within each group and between the two groups (p = .133 for VASFR and p = .215 for flexion reflex area). CONCLUSIONS: The same TENS protocol had different degrees of antinociceptive influence on chronic and acute pain in chronic low back pain patients.

Adolescent↗

PubMed2002

Unusual neuroenteric cysts: diagnosis and management.

Six cases of unusual neuroenteric (NE) cysts, occurring in children aged 15 months to 18 years, are reported here. Three of the cysts were extramedullary, while the other three were intramedullary. Two of the extramedullary cysts were located at the lumbosacral region, an unusual site. Only one patient had the cyst located in a ventral relation to the cord in the cervicothoracic region. None of the patients had communication with the mediastinum or intraabdominal viscera. Stigmata of spinal dysraphism were seen in three patients. All the children had variable neurological involvement and it was difficult to differentiate NE cyst from other causes of spinal cord or cauda equina lesion, particularly in the absence of some dysraphic marker. One patient presented with minimal neurological deficits and painful torticollis; this patient was suspected to have an atlantoaxial dislocation. All patients were investigated with MRI, and the only diagnostic feature of an NE cyst was an intradural cyst with an anterior vertebral body anomaly in a single case. It was not possible to radiologically differentiate NE cyst from other intraspinal cysts in the rest of the patients. All patients were operated on by the posterior route; an attempt to excise the cyst nearly in toto was made. Evidence of neural tethering most probably due to cyst contents was seen in three patients. All patients improved after surgery. None showed recurrence of the cyst at follow-up of 3 months to 2 years.

Adolescent↗

PubMed2001

Luteal and clinical response following administration of dinoprost tromethamine or cloprostenol at standard intramuscular sites or at the lumbosacral acupuncture point in mares.

OBJECTIVE: To determine whether administration of a microdose of prostaglandin at the BAI HUI acupuncture point offers any advantage over IM injections for luteolysis, ovulatory interval, or systemic response in mares. ANIMALS: 17 mature cycling mares, 3 to 20 years of age and weighing 400 to 500 kg. PROCEDURE: Conventional and microdoses of the prostaglandin dinoprost tromethamine (PGF2alpha), the analogue cloprostenol, or sterile water (control) were administered to mares in 7 treatment groups. Treatments were assigned by dose, administration site (semimembranosus, semitendinosus, or lumbosacral region), and treatment type (PGF2alpha, analogue, or sterile water). Mares were observed for ovulatory interval and systemic response to treatment, including heart, and respiratory rates, rectal temperature, and sweat score. Plasma progesterone concentrations were also determined at the time of treatment and at 24-hour intervals for 96 hours following treatment. RESULTS: Ovulatory interval was shortened and progesterone concentrations decreased in prostaglandin-treated mares, compared with control mares, regardless of dose or treatment site. However, no differences in ovulatory interval were observed among prostaglandin-treated mares. Mares treated with conventional doses of PGF2alpha had greater systemic responses than mares treated with microdoses of PGF2alpha or sterile water. CONCLUSIONS AND CLINICAL RELEVANCE: Administration of prostaglandins at the BAI HUI acupuncture point does not appear to offer any advantage over administration at standard IM injection sites for induction of luteolysis or to shorten the ovulatory interval. However, administration of a microdose of the analogue cloprostenol was effective at inducing luteolysis and shortening ovulatory interval regardless of administration site.

Abortifacient Agents, Nonsteroidal↗

PubMed1989

[Tethered cord syndrome of adult onset: report of a case and a review of the literature].

A 47-year-old female was admitted with complaints of spontaneous pain at the medial surface of the right thigh, and worsening of urinary incontinence and weakness of the legs. These phenomena had been noticed previously 20 years ago, and again 10 years ago, respectively. There was a scar like skin abnormality of 4 X 6 cm over the lumbosacral region. Compression on this region induced neuralgic pain around the anus radiating down to both legs. Neurologically, weakness of the legs, sensory impairment on the L2-S5 dermatomes and urinary incontinence were recognized. Plain X-P revealed spina bifida on the lower lumber and sacral vertebrae (L4-S1), where a low density mass was found by spinal CT. Metrizamide CT myelography and MRI disclosed medullaris to be low and the spinal cord to be elongated. There was a meningocele surrounded by subcutaneous lipoma at the caudal end of the spinal cord at L5 level. Upon operation, a meningocele containing neural elements and adherent to the intra and extra-dural lipoma was found protruding through the laminar defect. Lipoma was removed partially. The conus medullaris and cauda equina were freed from the surrounding tissue. Dural plasty using the Lyodura was made. Postoperatively, the pain disappeared and her gait disturbance and sensory impairment were significantly improved, but urinary incontinence remained unchanged. Fifty-six cases of tethered cord syndrome of adult onset were reviewed from the literatures. Clinical symptoms, etiologies of the tethering, surgical outcomes and factors causing symptoms were discussed.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗

PubMed1988

[A case of lumbosacral lipoma and its interesting histological findings].

A case of 3-month-old girl with lumbosacral lipoma is reported. She had a large soft tissue mass (4 X 5 cm) in the lumbosacral region initially noted at birth. Interpendicular distances below L2 were dilated on X-P. CT image demonstrated a sharply outlined low density area (approximately -80 H. U.) which occupied the latter half of the spinal canal in the level of L2 to S1 level. Defect of vertebral arch was also seen. Lipoma was removed subtotally with laminectomy. CT image demonstrated clear sharp margin of the tumor, neural tissue free zone were not found intraoperatively. Post-operative course was uneventful. Specimen showed the mature adipose tissue which contained rich blood vessels and connective tissue. Connective tissue was composed of collagen fibers and elastic fibers. Small aberrant nerve fibers and smooth muscle fibers were sporadically noted in specimens obtained from nearby transitional area of its lipoma and spinal cord. Although there were a few reports about the morphology of lipoma, the existence of nerve cell, neuroglia, embryonic bone, cartilage, smooth muscle fiber, striated muscle fiber, respiratory-like cell and others were reported in the previous reports. Our histological findings also suggest that the lipoma possibly arise from pluripotential caudal cell mass which survived by disturbance of the 3rd stage of neural tube formation (retrogressive differentiation).

Female↗

PubMed2001

Predictors of outcome after dorsal decompressive laminectomy for degenerative lumbosacral stenosis in dogs: 69 cases (1987-1997).

OBJECTIVE: To identify predictive factors of long-term outcome after dorsal decompressive laminectomy for the treatment of degenerative lumbosacral stenosis (DLSS) in dogs. DESIGN: Retrospective study. SAMPLE POPULATION: 69 client-owned dogs. PROCEDURE: Medical records of dogs that had undergone dorsal laminectomy at North Carolina State University and the University of Tennessee between 1987 and 1997 were reviewed. Dogs with diskospondylitis, traumatic lesions, or neoplasia of the lumbosacral region were excluded. All dogs had evidence of cauda equina compression on myelography, epidurography, computed tomography, or magnetic resonance imaging, along with subsequent confirmation of the lesion at surgery. Follow-up was performed by telephone inquiries to the referring veterinarian, the owner, or both, using a detailed questionnaire. RESULTS: The outcome was excellent or good in 54 of 69 (78%) dogs over a mean follow-up period of 38+/-22 months. Five of these 54 dogs had been incontinent for a median of 2 weeks prior to surgery. Six of the 15 dogs with a poor outcome had been incontinent for a median of 8 weeks before surgery. A significant correlation was detected between the presence of urinary and fecal incontinence prior to surgery and outcome. When duration of signs was considered, urinary incontinence was the only variable that significantly affected outcome. CONCLUSIONS AND CLINICAL RELEVANCE: Decompressive laminectomy is an effective treatment for DLSS, although dogs with urinary or fecal incontinence have a worse prognosis than dogs that are continent before surgery. Chronic urinary incontinence is a predictor of poor outcome for dogs with DLSS.

Animals↗

PubMed2003

The blood-brain barrier of the chick glycogen body (corpus gelatinosum) and its functional implications.

Among recent vertebrates only birds possess a glycogen body (corpus gelatinosum), located in the rhomboidal sinus of the lumbosacral region of the spinal cord and separated from the neural tissue proper. Because of the specific topographical situation of this circumventricular organ, the structure of its vascular system is of special interest with respect to the still unsolved functional problems. The existence of a blood-brain barrier is demonstrated by the exclusion of intravascularly injected tracer (horseradish peroxidase), and immunocytochemical demonstration of glucose transporter-1 as a functional marker and of neurothelin, occludin and ZO-1 as structural markers. Alkaline phosphatase and gamma-glutamyltransferase activities, two enzyme reactions frequently used for demonstration of an established blood-brain barrier in vitro, were localized histochemically on the plasmalemma of glycogen body cells and were absent from the endothelium. In addition, local enlargements of the intercellular space were observed by transmission and scanning electron microscopy. In accordance with the concept of a third circulation the cerebrospinal fluid may be the vehicle for distributing substances originating in the glycogen body to the CNS, while the vascular endothelium maintains the internal milieu by virtue of its dynamic barrier functions.

Alkaline Phosphatase↗