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The patient with acute neurological problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Spinal nerves are arranged as follows: 8 pairs of cervical nerves (C1–C8).12 pairs of thoracic nerves (T1–T12).5 pairs of lumbar nerves (L1–L5).5 pairs of sacral nerves (S1–S5).1 pair of coccygeal nerves (Co1).
The Nervous System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
All the nerves may be divided into two physiologic areas, the central nervous system (CNS) and the peripheral nervous system. The CNS is comprised of the cerebral cortex, basal regions of the brain, and the spinal cord. The spinal cord extends down from the foramen magnum of the skull to the first lumbar vertebra and is surrounded and protected by the vertebral column. It contains two enlargements known as the cervical and lumbosacral enlargements from which emerge the spinal nerves innervating the upper and lower limbs. The 31 pairs of spinal nerves are named for the vertebrae from which they emerge. For example, the 12 spinal nerve pairs in the thoracic region are referred to as T1 through T12. Similarly, the five lumbar nerves are denoted with the letter L, the five sacrals with the letter S, and the one coccygeal as Co1.
The locomotor system
Published in Peter Kopelman, Dame Jane Dacre, Handbook of Clinical Skills, 2019
Peter Kopelman, Dame Jane Dacre
With the patient supine on the couch, assess straight leg raising: Lift the leg by placing your hand underneath the ankle and passively flex the hip, keeping the knee extended. When the limit is reached, perform the sciatic stretch test by passively dorsiflexing the ankle. The test assesses irritation of the low lumbar and upper sacral nerve roots. The result is positive if the patient complains of sensory disturbance (pains, pins and needles, or numbness) anywhere below the knee.Now ask the patient to turn over. Remove the pillow from the head of the couch and place it under their pelvis and abdomen. This slightly flexes the lumbar spine and is a comfortable position for the patient. Palpate down the spinous processes in turn and along the erector spinae muscles, looking for tenderness.Then perform the femoral stretch test. This is the counterpart of the sciatic stretch test and assesses irritation in the upper lumbar nerve roots, which contribute to the femoral nerve. Passively flex the person’s knee and, holding the foot, gently extend the hip. If this provokes spasm of the quadriceps and the patient complains of sensory disturbance over the front of the thigh, the test is positive.
Biportal endoscopic technique in the treatment of spinal stenosis: early clinical experiences and results
Published in Neurological Research, 2020
Gábor Czigléczki, Zoltan Nagy, Csaba Padányi, Péter Banczerowski
Retrospectively, we identified and collected 21 patients in our retrospective analysis. There were 12 female (57.1 %) and 9 male (42.9%) patients. The mean age of the patients was 66.5 years (range from 30 to 83 years). All of the patients had some other diseases (cardiovascular or respiratory problems) that would have contraindicated open surgeries. The duration between the onset of symptoms and the time of surgery was a long period in most of the cases which overlaps with the natural history of degenerative spinal stenosis. The mean duration time was 32 months (range from 3 to 72 months). All of the patients had one level or multilevel degenerative spinal stenosis which was confirmed with MR examinations. The LIII-LIV level was affected in 3 cases (14.3%) and the LIV-V level in 14 cases (66.7%). Multiple stenosis involving two segments was observed in four cases (19%). Preoperative symptoms included pain, motor and sensory symptoms, vegetative disorders and claudication. All of the patients had preoperatively local lumbar pain and radiating pain according to the affected spinal segment and side. The right side was symptomatic in 7 cases (33.3%) and the left side in 14 cases (66.7%). Five patients (23,8 %) had preoperative dorsal flexion paresis (only mild paresis). 16 patients (76.1%) presented with sensory disturbance such as paresthesia according to the affected lumbar nerves. Three patients (14.2%) had urinary disturbances. Claudication (<100 m) was observed in 11 cases (52.3%).
Halo-pelvic traction for extreme lumbar kyphosis: 3 rare cases with a completely folded lumbar spine
Published in Acta Orthopaedica, 2020
Yu Wang, Chunde Li, Long Liu, Longtao Qi
Currently, spinal kyphosis is primarily treated with osteotomy and posterior fusion (Wang et al. 2015, Zhou et al. 2018, Hua et al. 2019, Zhang et al. 2019). However, performing a vertebral osteotomy via a posterior approach is difficult when a kyphosis is “folded” or the lumbar spine is collapsed. The procedure is difficult because all the nerve roots are compressed in a very small region of the posterior lumbar spine. The nerve roots block access for performing the vertebral osteotomy and mesh insertion; indeed, it is difficult to perform a vertebral osteotomy and mesh insertion through the limited space between any 2 lumbar nerve roots. Furthermore, the lumbar nerve roots are not as dispensable as some thoracic spine nerve roots. This problem can be solved by HPT, application of which spreads the nerve roots apart making it easier to perform a posterior osteotomy (Yu et al. 2016).
Reliability of S3 pressure sensation and voluntary hip adduction/toe flexion and agreement with deep anal pressure and voluntary anal contraction in classifying persons with traumatic spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2020
Ralph J. Marino, Mary Schmidt-Read, Anna Chen, Steven C. Kirshblum, Trevor A. Dyson-Hudson, Edelle Field-Fote, Ross Zafonte
At follow-up the difference between VHTC and VAC did impact AIS grade in some cases. This occurred only in subjects with a neurologic level below T10 at the time of the examination. A review of the cases found that these subjects had fractures between T11 and L2, and likely had conus medullaris injuries. At the conus, a highly organized overlapping pattern of nerve roots is present. Specifically, an oblique layering pattern is seen for nerve roots from L2 to L5 which overlaps the terminal spinal cord, with the most rostral roots lying more laterally. Typically lumbar nerve roots adjacent to the spinal cord proper are seen starting caudal to the T10–T11 disc level.10 This may result in the lumbar roots being spared or partially spared in a conus medullaris spinal cord injury, a phenomenon known as “root escape”. As support for this theory of root escape, in three of four cases VHTC was based on the presence of hip adductor (L2–L3 roots) contraction, with absence of toe flexor (S1–S2 roots) contractions. There was one major difference in classification where AIS grade was B but alt-AIS grade was D. This subject had an L3 neurologic level, sensory sacral sparing, no VAC but positive VHTC. Even though LEMS was 38, the AIS grade was B because the anal sphincter is the only muscle more than three levels below the motor level so the criteria for motor incomplete could not be met.