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Adult Isthmic Spondylolisthesis
Published in Kelechi Eseonu, Nicolas Beresford-Cleary, Spine Surgery Vivas for the FRCS (Tr & Orth), 2022
Kelechi Eseonu, Nicolas Beresford-Cleary
The cause of isthmic spondylolisthesis is thought to be multifactorial. The pars interarticularis is subject to maximal mechanical stress at the lumbosacral junction and the coronal orientation of the lower lumbar facet joints. In the lower lumbar spine, the cross-sectional anatomy of the pars is relatively thin.
Scottie Dog Sign
Published in Michael E. Mulligan, Classic Radiologic Signs, 2020
‘With a little imagination,’ one can detect the form of a small dog in the outline of a lumbar vertebral body’s parts as seen on an oblique radiograph (Figure 1). This simple observation, reported by A.-P. Lachapèle1 in 1938, has provided radiologists with an easy method of remembering the complex anatomy in this crucial area. Lachapèle (Hopital Saint-Andre’ de Bordeaux) compared the anatomic outline to Pol Rab’s cartoon character Scottish terrier ‘Rac’2 (Figures 2 and 3), thus giving us the ‘Scottie dog.’ The most important feature is the ‘neck’ of the Scottie dog. This corresponds to the pars interarticularis and it is the site of abnormality when spondylolysis is present. A break in the neck of the dog or a collar on the dog’s neck is indicative of spondylolysis. In the very next article in the journal Lachapèle3 discussed cases of spondylolysis and illustrated how the ‘Scottie dog’ analogy applies to the radiographic findings. A renewed emphasis was placed on the importance of spondylolysis detection in the 1950s because of the increased use of preplacement lumbar spine X-rays for industrial workers and heavy laborers.
Anatomy for neurotrauma
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Vasudha Singhal, Sarabpreet Singh
The vertebral arch is formed by a pair of pedicles, and a pair of laminae, along with two transverse processes pointing laterally, and a spinous process pointing posteriorly. Articular processes—two superior and two inferior—are located at the junction of lamina and pedicles, and articulate with their counterparts on the vertebrae above and below. The part of the vertebra located between the superior and inferior articular processes of the facet joint is called the pars interarticularis. The facet joints between the articular facets of the adjacent vertebrae are strengthened by various ligaments—ligamentum flavum (between adjacent laminae), interspinous and supraspinous ligaments (between the spinous processes), and intertransverse ligaments (between the transverse processes). In between each pair of vertebrae, there are the intervertebral foramina on each side, which allow for the exit of spinal nerves.
Two–level reverse Bohlman transsoseous approach for treatment of symptomatic pseudarthrosis
Published in British Journal of Neurosurgery, 2019
Katie L. Krause, Caitlin DeDeaux, Enjae Jung, Khoi D. Than
Stabilization of the lumbosacral junction remains challenging. The lumbar lordosis across L5–S1 is such that the lumbosacral junction experiences both axial and shear forces, making a solid arthrodesis difficult. A high sacral slope has been found to be an important contributor to the generation of these forces, and directly influences the degree of lumbar lordosis.6,17 It has been suggested that patients with a high sacral slope, and thus with an exaggerated lordosis, develop more shear stress across the pars interarticularis, and can lead to spondylolisthesis.6 Surgically, this can lead to an increased complication rate, including progression of slip grade or angle, neurologic deficit,7 hardware failure, pseudarthrosis, and need for revision surgery.18
Factors associated with the recurrence of lumbar disk herniation: non-biomechanical–radiological and intraoperative factors
Published in Neurological Research, 2023
Anas Abdallah, Betül Güler Abdallah
Paramedian LD was the preferred approach in patients who had far lateral LDHs. With a microscope, a 2-cm lateral skin incision (3–4 cm lateral to the midline) was performed. After incising the underlying fascia, the crude dissection with the index finger through the multifidus and longissimus muscles was performed by preserving the facet joint without crossing the spinal canal. The lateral pars interarticularis and transverse process were reached. The exposed nerve was retracted superiorly to reach the herniated disk, and discectomy was achieved [14].
Factors associated with the recurrence of lumbar disk herniation: biomechanical–radiological and demographic factors
Published in Neurological Research, 2022
Anas Abdallah, Erhan Emel, Betül Güler Abdallah
Paramedian LD was the preferred approach in patients who had far lateral LDHs. With a microscope, a 2-cm lateral skin incision (3–4 cm lateral to the midline) was performed. After incising the underlying fascia, the crude dissection with the index finger through the multifidus and longissimus muscles was performed by preserving the facet joint without crossing the spinal canal. The lateral pars interarticularis and transverse process were reached. The exposed nerve was retracted superiorly to reach the herniated disk and discectomy was achieved [36].