The locomotor system
Peter Kopelman, Dame Jane Dacre in Handbook of Clinical Skills, 2019
Low back pain The lumbar spine should be examined with the patient standing, supine and prone: With the patient standing, assess the curvature of the spine. Scoliosis may be due to muscle spasm in acute sciatica or may be postural in leg length inequality. Loss of the normal lordosis is a sign of inflammatory spinal disease, such as ankylosing spondylitis.Palpate the erector spinae muscles to assess spasm.Perform a modified Schober’s test (see Box 5.7 and Fig. 5.14).Ask the patient to lean over to each side in turn and run their hand down the side of the leg to the knee; this assesses lateral flexion.Then ask the patient to lean over backwards to assess extension. If extension is painful, facet joint disease (usually degenerative) may be present.
Percutaneous Lysis of Lumbar Epidural Adhesions and Hypertonic Saline Neurolysis
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
Kuslich et al.32 identified intervertebral discs, nerve root dura, facet joints, ligaments, fascia, and muscles as tissues capable of transmitting pain in the low back and lower extremity. The pathophysiology of spinal radicular pain continues to be a subject of ongoing research and controversy. Proposed etiologies include neural compression with dysfunction, vascular compromise, inflammation, and biochemical influences.33 Multiple causes described for chronic low back and lower extremity pain include not only disc herniation with neural compression and dysfunction, but also vascular compromise, inflammation, biochemical influences, postlumbar laminectomy syndrome, and spinal stenosis. Postlumbar laminectomy syndrome or pain following operative procedures of the lumbar spine is estimated in approximately 5 to 40% of patients after surgical intervention.11,13,34–37 Although there are multiple etiologies responsible for postlumbar laminectomy pain, descriptions of causes of continued pain after surgical intervention have included epidural fibrosis, facet joint arthritis, spinal stenosis, and other causes.
Animal Models for Reconstruction of Vertebral Column and Intervertebral Disc
Yuehuei H. An, Richard J. Friedman in Animal Models in Orthopaedic Research, 2020
The authors reported a basic procedure of allogenic intervertebral disc grafting in dogs.8 The lumbar spine (LI-7) was removed using a sterile technique from 11 mongrel dogs (15 kg average BW) to prepare disc units for transplantation. In order to fix a disc in the recipient lumbar spine without fail, it was removed with adjacent vertebrae transected about 1 cm apart from the surfaces facing the disc so that the cut surfaces could be fixed to the cut surfaces of the recipient vertebrae by bone fusion (Figure 1). Eight disc units were immersed for impregnation in 10% dimethyl sulfoxide (DMSO) at 4°C for one hr, and stored at -80°C for 1-16 weeks (mean, eight weeks). Another group of eight disc units were immersed for impregnation in 10% DMSO at 4°C for three hours, and frozen at -30 for one hr and further at -80°C for one hr, and then stored in liquid nitrogen at -196°C for 1-6 weeks (mean, four weeks) until transplantation.
Effects of backrest and seat-pan inclination of tractor seat on biomechanical characteristics of lumbar, abdomen, leg and spine
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2023
Qichao Wang, Yihuan Huo, Zheng Xu, Wenjie Zhang, Yujun Shang, Hongmei Xu
The spine plays various roles in supporting the trunk, protecting the internal organs, controlling human movement and protecting the spinal cord. The adult spine consists of 26 vertebrae, including seven cervical vertebrae (C1–C7), 12 thoracic vertebrae (T1–T12), five lumbar vertebrae (L1–L5), one sacral vertebra and one caudal vertebra from the top to the bottom. The load of spine in different parts is the sum of the weight of the above limbs, muscle tension and external load. Therefore, the spine gradually widens from the top to the bottom, which is in line with the gradual increase in spinal load. The thoracic vertebra is the most important part of human spine, playing important roles in maintaining the stability and driving the movement of human upper limbs. The lumbar spine is located at the bottom of the spine, acting as a junction of the movable segment and the fixed segment. It bears a large load and is the most frequent site for the occurrence of lumbar occupational diseases. Based on these facts, this study selected some thoracic segments and the whole lumbar segment as the objects for analysis.
Spinal biomechanics modeling and finite element analysis of surgical instrument interaction
Published in Computer Assisted Surgery, 2019
Weixing Guan, Yu Sun, Xiaozhi Qi, Ying Hu, Chunguang Duan, Huiren Tao, Xiaojun Yang
The lumbar vertebrae are mainly composed of vertebral body and intervertebral discs. And as shown in Figure 1, vertebral body mainly includes transverse processes, spinous processes, upper/lower articular process, vertebral foramen, lamina and papillae. The intervertebral disc is composed of the upper and lower endplates, the nucleus pulposus and the annulus fibrosus [1]. The upper and lower endplates are located at the bottom and top of the annulus fibrosus and they are the cartilage structure, which can be considered as elastic body. The nucleus pulposus is located in the middle of the annulus fibrosus, which is the incompressible fluid structure and belongs to the viscoelastic body and can withstand greater pressure. The annulus fibrosus which belongs to the super elastic body, surrounds the nucleus pulposus and connects the adjacent vertebrae through the upper and lower endplates [2,3]. The vertebral body consists of cortical bone and cancellous bone and the material parameters of the two parts are different [4].
Biomechanical analysis of lumbar interbody fusion cages with various lordotic angles: a finite element study
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2018
Zhenjun Zhang, Guy R. Fogel, Zhenhua Liao, Yitao Sun, Weiqiang Liu
There are some limitations in this finite element study, such as using a unique lumbar model, simplifying the material properties of some tissues, and ignoring the role of muscles. First of all, the geometric model of lumbar spine varies from person to person, such as disc height and the joint space. But in the present study only one model of lumbar spine was chosen. Secondly, although the components of lumbar spine are nonlinear in reality, the material properties of them were simplified as linear elastic in this study. However, many FEA on lumbar spine have assumed that the components was linear in order to improve the calculation efficiency (Grauer et al. 2006; Vadapalli et al. 2006; Zhong et al. 2006; Kim et al. 2010; Choi et al. 2016; Zhang et al. 2017). In addition, the muscles have an important contribution to support the stability of lumbar spine. But the muscles were not considered in this study. However, the tendency of predicted results with varied lordotic angles of cage would not be substantially changed depending on the personalized geometric model, material properties of components, and model of the muscles.
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