Unexplained Fever In Urology
Benedict Isaac, Serge Kernbaum, Michael Burke in Unexplained Fever, 2019
The association between genitourinary surgery and the subsequent development of spinal osteomyelitis is well documented. The frequency of vertebral involvement in urinary tract infection varies from 10 to 70%. Prostatectomy or pyelolithotomy, and especially operations on pyonephrotic kidneys might result in vertebral osteomyelitis some months after operation. Spinal osteomyelitis affects the vascular metaphyseal region beneath the anterior longitudinal ligament, and then spreads across the disc via the nutrient vessels to involve adjacent vertebral bodies. Unlike malignant deposits, infective lesions destroy the disc space. Lumbar vertebrae are most often involved; T8-9 to L3-4 lesions have been reported. It occurs mainly in adults with a mean age between 60 and 70 years. Fever, back pain, and stiffness are the major findings in vertebral osteomyelitis. The first modifications seen by radiology do not appear before 2 to 8 weeks of evolution of the disease. Early technetium-99m bone scans are of great diagnostic help.158-162
Test Paper 3
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike in Get Through, 2017
A 17-year-old man presents with new onset back and loin pain. A low-dose CT KUB reveals a sclerotic lesion in the lamina of one of the thoracic vertebra. Which one of the following statements concerning osteoid osteomas of the spine is true? They can cause painful scoliosis.Involvement of the lumbar vertebrae is atypical.Lesions of more than 2 cm in diameter are more common on presentation.The ‘nidus’ within the lesion is osteosclerotic.They rarely enhance on MRI after intravenous administration of contrast material.
Blocks of Nerves of the Lumbar Plexus Supplying the Lower Extremities
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand in Pediatric Regional Anesthesia, 2019
The lumbar plexus is formed by the fusion of the ventral rami of the first four lumbar spinal nerves (Figure 2.1, A and B). It usually receives a branch from the twelfth thoracic nerve and gives a branch (from the fourth lumbar spinal nerve) to the sacral plexus. The lumbar plexus lies within the substance of the psoas major muscle, in a fascial plane delineated by (1) the dorsal muscle mass attached to the transverse processes of the lumbar vertebrae, (2) the ventral mass attached to the vertebral bodies and intervertebral disks, and (3) the bodies and transverse processes of the lumbar vertebrae (Figures 2.1C and 2.2). This fascial plane has been termed “psoas compartment” by Chayen et al.12
Analysis of stress and stabilization in adolescent with osteoporotic idiopathic scoliosis: finite element method
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2023
Qiaolin Zhang, Yan Zhang, Teo. Ee Chon, Julien S. Baker, Yaodong Gu
The images were segmented using Mimics 20.0 (Materialise, Leuven, Belgium) to obtain the boundaries of the skeleton. The uneven surfaces caused by stacking of the medical images were processed using Geomagic Studio (2013) (Geomagic, Inc., Research Triangle Park, NC, United States). Each surface component was then imported into Solidworks 2020 (SolidWorks Corporation, MA, United States) individually to form solid parts. The annulus fibrosis, nucleus pulposus, endplate, and articular cartilage were established in Solidworks 2020 according to the anatomical characteristics of the lumbar spine. The thickness of the cortical bone of the vertebral body ranges from 0.18 mm to 0.6 mm (Ritzel et al. 1997). The average thickness of cortical bone is about 0.2 mm. The width of the lumbar vertebrae is larger than that of the thoracic or cervical vertebrae. The thickness of cortical bone does not depend on individual sex but decreases with age. In this study, the thickness of cortical bone is 0.4 mm and the thickness of endplate is 0.5 mm (Gómez et al. 2017).
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].
Contralateral lumbosacral plexopathy following lumbar microdiscectomy
Published in British Journal of Neurosurgery, 2020
Isabel Tulloch, Riaz Ali, Marios C. Papadopoulos
LSP has been reported to occur following instrumented lumbar spinal procedures, for example posterior or transforaminal lumbar interbody fusion.5,6 These authors attributed LSP to direct trauma occurring due to the lumbar plexus, located just anterior to the transverse processes of the lumbar vertebrae, being damaged during instrumentation and lateral paraspinal muscle dissection.7 However, our patient’s microdiscectomy procedure involved a minimal unilateral muscle strip, without any lateral breach towards the transverse process or lumbar plexus. Her plexopathy was contralateral to the operative site, making direct trauma from surgical instrumentation or traction near impossible as no muscular or bony dissection or significant neural mobilisation was performed on the contralateral side.
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