Animals ; Humans ; Intervertebral Disc Degeneration ; physiopathology ; Low Back Pain ; etiology ; pathology ; Lumbar Vertebrae ; blood supply ; Risk Factors ; Smoking ; adverse effects

OBJECTIVETo study the anatomy of veins of the lower lumbar spine and provide the anatomic basement for laparoscopic lumbar surgery.

METHODSA total of 15 formaldehyde-preserved cadavers were studied with special attention to the variety and surrounding structure of ascending lumbar vein (ALV) and iliolumbar veins (ILV), and their relationship with lumbar plexus.

RESULTSALV and ILV can be found on every sides, which have four variants including separate entry and common entry. The ascending vein and iliolumbar vein separately enter common iliac vein in 18 cases, and as a common stem enter the common iliac vein in 12 cases. Retracting common iliac vein medially both the ascending lumbar and the iliolumbar veins are always at risk of avulsion on exposure of the disc space. The injury of obturator nerve and lumbosacral trunk of lumbar plexus should be avoided.

CONCLUSIONAwareness of these anatomic variation can prevent the hemorrhage and be helpful for the surgeon in performing a careful ligation of these veins before medial retraction of the common iliac vein. Our findings emphasize the need for proper dissection of ALV and ILV before ligature during exposure of the lower lumbar spine.

Cadaver ; Endoscopy ; Female ; Humans ; Lumbar Vertebrae ; blood supply ; Lumbosacral Region ; surgery ; Male ; Retroperitoneal Space ; Veins ; anatomy & histology

OBJECTIVETo assess the diagnosis and treatment of venous hypertensive myelopathy (VHM) caused by narrowing of the ascending lumbar vein.

METHODThe data from 3 patients with VHM caused by narrowing of the ascending lumbar vein were analyzed retrospectively.

RESULTSOnce the narrowed site of the lumbar ascending vein was determined by myelographic or angiographic technique, an undetachable balloon was introduced and advanced to the proximal part of the narrowed segment. Satisfactory results were obtained in these patients.

CONCLUSIONNarrowing of the ascending lumbar vein is one of the causes for VHM, and endovascular balloon angioplasty is an optimal treatment.

Aged ; Humans ; Hypertension ; etiology ; Lumbar Vertebrae ; blood supply ; Male ; Middle Aged ; Retrospective Studies ; Spinal Cord Vascular Diseases ; etiology ; Venous Pressure

Spontaneous retroperitoneal hemorrhage is a distinct clinical entity that can present in the absence of specific underlying pathology or trauma and is typically associated with anticoagulation therapy. We report a case of a 74-year-old female patient with a cerebral infarction related to atrial fibrillation who developed a spontaneous lumbar arterial hemorrhage complicating heparin therapy. The diagnosis was suggested by a computed tomography scan and confirmed by angiography. She was treated successfully with transcatheter embolization.
Aged ; Anticoagulants/*adverse effects ; *Embolization, Therapeutic ; Female ; Hemorrhage/etiology/radiography/*therapy ; Heparin/*adverse effects ; Humans ; Lumbar Vertebrae/*blood supply ; Retroperitoneal Space ; Therapeutics ; Tomography, X-Ray Computed

BACKGROUNDAlthough three-dimensional MRI (3D-MRI) of short T1 inversion recovery turbo spin-echo (STIR TSE) has showed superior to two-dimensional MRI (2D-MRI) in showing the spinal cord and lumbar nerve roots, it remains difficult in demonstrating radicular vein at present. We have found that short T1 inversion recovery long time echo (STIR LONG TE) was better in showing radicular vein. To further study the methods and character of the 3D-MRI of lumbar nerve root, ganglions and radicular vein in normal and lumbar disc herniation (LDH) adults, in the present study, we evaluated two 3D-MRI techniques, STIR TSE and STIR LONG TE for demonstrating lumbar nerve roots and especial radicular vein in normal and LDH adults.

METHODSTwelve normal adult persons and 19 LDH patients were included in this study; special oblique coronal location was adopted. STIR TSE and STIR LONG TE were performed in all participants, and the detection rates of radicular vein and nerve root of L3, L4, L5, S1 were calculated. The grading system was used in grading compromise of the intraspinal extradural lumbar nerve root, ganglion and radicular vein in LDH patients, and all the grading injury of nerve root, ganglion and radicular vein had been evaluated.

RESULTSThe definite rate of radicular vein (DRRV) of 3D-MRI of STIR LONG TE was significantly different from that of STIR TSE. DRRV of STIR LONG TE was L3, 91.7%, L4, 100%, L5, 100%, S1, 100% and that of STIR TSE was L3, 33.3%, L4, 37.5%, L5, 58.3%, S1, 45.8% in normal adults. It showed no difference between STIR LONG TE and STIR TSE in the detection rate of nerve root. The different patho-injuries of nerve root, ganglion and radicular vein could be seen in all LDH patients by the 3D-MRI of STIR LONG TE. The mean score of Japanese Orthopaedic Association (JOA) was 16.16, and 29 nerve roots were calculated in all the study. The mean grading injury of nerve root was 2.17, that of nerve root ganglion was 1.28, that of radicular vein was 1.83, and the mean co-grading injury of nerve root, ganglion and radicular vein was 5.31. The correlation coefficient was 0.478 (P = 0.010) between the score of JOA and that of radicular vein.

CONCLUSIONThe 3D-MRI of STIR LONG TE is superior to STIR TSE for not only detecting the lumbar nerve root, ganglion and especial radicular vein in normal adults, but also displaying their patho-injuries degree in LDH patients.

Adult ; Aged ; Female ; Humans ; Intervertebral Disc Displacement ; pathology ; Lumbar Vertebrae ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Spinal Nerve Roots ; blood supply ; pathology ; Veins ; pathology

OBJECTIVETo investigate the blood supply of the pedicle fat grafts with the third lumbar segmental artery and its clinical effects on reoperation for lumbar disc herniation.

METHODSTwelve sides of 6 adult cadaver examples were contributed to investigate the courser of lumbar segmental vessels and the distribution of hypodermic capillary net of the dorsal branch of the third lumbar segmental artery. From January 2000 to January 2007,49 patients needed reoperation to treat lumbar disc herniation,including 26 males and 23 females with an average age of 55.6 years (ranged from 39 to 70 years). Duration between two operations ranged from 8 months to 15 years with an average of 6.9 years. Reoperative reasons included recurrent lumbar disc protrusion(30 cases)postoperative epidural scar formation (17 cases), postoperative epidural cyst formation (2 cases). Of them,9 patients underwent posterior lumbar interbody fusion at the second operation. The pedicle fat grafts with the third lumbar segmental artery were covered on the sites of the laminectomy in these patients. After negative pressure drainage tube were pulled out, 2 ml Chitsan were injected to the sites of the laminectomy and around epidural nerve root through epidural catheter. VAS score and the Oswestry Disability Index (ODI) were used to assess clinical outcomes before and after operation.

RESULTSThe courser of third lumbar segmental vessels were invariant at the lateral face of the lumbar vertebral body. The dorsal branch of the third lumbar segmental artery penetrated thoracolumbar fascia and formed rich hypodermic capillary net in the region. All patients were followed up from 5 to 8 years with an average of 5.6 years. VAS score of low back pain and leg pain decreased respectively from preoperative 7.6 +/- 1.2, 8.9 +/- 0.9 to 3.6 +/- 0.5, 3.0 +/- 0.4 at final follow-up (P < 0.01); and ODI score decreased from preoperative 44.1 +/- 6.2 to 13.9 +/- 3.6 at final follow-up (P < 0.01). According to ODI score to evaluate the clinical outcomes, 29 cases got excellent results, 11 good, 7 fair, 2 poor.

CONCLUSIONThe pedicle fat grafts with the third lumbar segmental artery and Chitsan can reduce epidural scar formation and prevent peridural fibrosis and adhesion and improve clinical effects of reoperation for lumbar disc herniation.

Adipose Tissue ; pathology ; Adult ; Aged ; Arteries ; pathology ; physiopathology ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; pathology ; physiopathology ; surgery ; Lumbar Vertebrae ; blood supply ; pathology ; surgery ; Male ; Middle Aged ; Reoperation ; Transplantation ; Treatment Outcome

OBJECTIVETo observe the effect of hallux-trampling (HT) combined with Yaotongling suppository (YS) on the microcirculation at waist region and lower limbs in treating patients with lumbar intervertebral disc prolapse (LIDP), and to preliminarily explore its mechanism.

METHODSAdopting randomized, double-blinded medicine and single-blinded manipulation controlled method, 108 patients with LIDP of cold-accumulation and blood-stasis syndrome were assigned equally to 3 groups in random. Group A was treated with HT plus YS, Group B treated with HT plus placebo suppository, and Group C treated with YS plus mock HT. After 2-week treatment, the changes in score of symptoms and signs as well as the microcirculation at various site-points of waist and lower limbs were observed before and after treatment.

RESULTSThe total scores of symptoms and signs after treatment in Group A, B and C was 7.340 +/- 4.627, 9.543 +/- 4.745 and 10.086 +/- 4.631 respectively, which was significantly lowered as compared with those before treatment respectively (P < 0.05). Significant difference of microcirculation between pre- and post-treatment was shown at all site-points in Group A and B (P < 0.05), but only shown at the site-points of lower limbs in Group C, so significant difference (P < 0.05) was shown when compared the microcirculation in Group A or B with that in Group C (P < 0.05).

CONCLUSIONHT combined YS in treating LIDP could markedly improve the microcirculation at waist and lower limbs to correct the nutritional disturbance of nerve root, and the improvement of microcirculation is correlated with the changes of clinical symptoms and signs.

Adult ; Aged ; Combined Modality Therapy ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Intervertebral Disc Displacement ; drug therapy ; physiopathology ; therapy ; Lumbar Vertebrae ; blood supply ; drug effects ; Male ; Massage ; Microcirculation ; drug effects ; Middle Aged ; Suppositories ; Young Adult