Clinical trials have demonstrated that kilohertz-frequency transcutaneous spinal cord stimulation (TSCS) can be used to facilitate the recovery of sensory-motor function for patients with spinal cord injury, whereas the neural mechanism of TSCS is still undetermined so that the choice of stimulation parameters is largely dependent on the clinical experience. In this paper, a finite element model of transcutaneous spinal cord stimulation was used to calculate the electric field distribution of human spinal cord segments T ₁₂ to L ₂, whereas the activation thresholds of spinal fibers were determined by using a double-cable neuron model. Then the variation of activation thresholds was obtained by varying the carrier waveform, the interphase delay, the modulating frequency, and the modulating pulse width. Compared with the sinusoidal carrier, the usage of square carrier could significantly reduce the activation threshold of dorsal root (DR) fibers. Moreover, the variation of activation thresholds was no more than 1 V due to the varied modulating frequency and decreases with the increased modulating pulse width. For a square carrier at 10 kHz modulated by rectangular pulse with the frequency of 50 Hz and the pulse width of 1 ms, the lowest activation thresholds of DR fibers and dorsal column fibers were 27.6 V and 55.8 V, respectively. An interphase delay of 5 μs was able to reduce the activation thresholds of the DR fibers to 20.1 V. The simulation results can lay a theoretical foundation on the selection of TSCS parameters in clinical trials.
Humans ; Spinal Cord Stimulation/methods* ; Nerve Fibers/physiology* ; Finite Element Analysis ; Spinal Cord/physiology* ; Computer Simulation ; Spinal Cord Injuries/physiopathology* ; Lumbosacral Region ; Lumbar Vertebrae ; Transcutaneous Electric Nerve Stimulation/methods* ; Models, Neurological

OBJECTIVE: To analyze the causes of vascular injury occurred in oblique lateral interbody fusion for treating lumbar degenerative diseases, and put forward preventive measures. METHODS: There were 235 patients analyzed from October 2014 to May 2017 in five hospitals, who were treated with oblique lateral interbody fusion with or without posterior pedicle screw fixation. There were 79 males and 156 females with an average age of (61.9±13.5) years old (ranged from 32 to 83 years). There were 7 cases of vascular injury, including 4 cases of segmental vessel injury, 1 case of left common iliac artery injury, 1 case of left common iliac veininjury and 1 case of ovarian vein injury. RESULTS: The follow up time ranged from 6 to 36 months, averagely (15.6±7.5) months. There was no pedicle screw loosen or fracture. The low back pain VAS decreased from preoperative 6.7±2.3 to 1.4±0.8 at the latest follow-up, which was statistically difference( CONCLUSION Oblique lateral interbody fusion technique provides a new method for minimally invasive fusion of lumbar internal fixation. However, it has a risk of vascular injury. In order to effectively prevent the occurrence of vascular injury, the operative indications and careful and meticulous operation should be strictly grasped.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lumbar Vertebrae/surgery* ; Lumbosacral Region ; Male ; Middle Aged ; Pedicle Screws ; Retrospective Studies ; Spinal Fusion/adverse effects* ; Treatment Outcome ; Vascular System Injuries/surgery*

Morel-Lavallée is a rare lesion caused by post-traumatic soft tissue injury. It usually occurs around the greater trochanter, and it occurs very rarely in the lumbar region. It is often difficult to be diagnosed in the emergency room. Delayed diagnosis may result in the need for open surgery. The authors report a patient with extensive multiple Morel-Lavallée lesions in the thoracolumbar, buttock, and thigh after trauma and provide a literature review.
Buttocks ; Delayed Diagnosis ; Emergency Service, Hospital ; Femur ; Humans ; Lumbosacral Region ; Soft Tissue Injuries ; Thigh

OBJECTIVETo study the effects of sacral nerve root electrostimulation (SNS) on the colon function and its mechanisms in rats with spinal cord injury (SCI).

METHODSOne hundred and four Wistar rats were divided into three groups: A, B and C. A group ( n = 24) was divided into three subgroups (n = 8) for studying the bioelectricity: Normal group (NG), SCI group (SCI) and SCI group with SNS(SNS); B group( n = 24) was divided into three subgroups( n = 8) for studying the colon motility: NG, SCI and SNS. C group( n = 56) were divided into three groups for studying the change of morphology and neurotransmitters(SP and VIP): NG (n = 8), SCI (n = 24), and SNS (n = 24) . In SCI and SNS, included of three subgroups: 24, 48, 72 h after spinal cord injury (n = 8).

RESULTSIn SCI group, the activity of bioelectricity in proximal and distal colon was reduced; the colon motility was lessened, and colon mucosa appeared different degree of damage; cell-cell connections between intestinal epithelial cells were destroyed. The expressions of substance P(SP) and vasoactive intestinal peptide (VIP) in colon were decreased obviously. SNS was found to activate the bioelectricity, promote the colon motility, improve the intestinal mucosal, and increase the expressions of SP and VIP. Conclusion: SNS can activate the peristalsis, rehabilitate the motility of denervated colon, protection of the intestinal mechanical barrier between intestinal epithelial cells and tight junction, rebuild the colon function through activating the bioelectricity and increase the expressions of SP and VIP.

Animals ; Colon ; physiopathology ; Electric Stimulation Therapy ; Epithelial Cells ; drug effects ; Intestinal Mucosa ; drug effects ; Lumbosacral Region ; innervation ; Neurotransmitter Agents ; metabolism ; Rats ; Rats, Wistar ; Spinal Cord Injuries ; therapy ; Substance P ; metabolism ; Vasoactive Intestinal Peptide ; metabolism

Very rarely, spinal subarachnoid hemorrhage (SSAH) can occur without any direct spinal injury in patients with traumatic intracranial SAH. A-59-year-old male with traumatic intracranial subarachnoid hemorrhage (SAH) presented with pain and numbness in his buttock and thigh two days after trauma. Pain and numbness rapidly worsened and perianal numbness and voiding difficulty began on the next day. Magnetic resonance imaging showed intraspinal hemorrhage in the lumbosacral region. The cauda equina was displaced and compressed. Emergent laminectomy and drainage of hemorrhage were performed and SSAH was found intraoperatively. The symptoms were relieved immediately after the surgery. Patients with traumatic intracranial hemorrhage who present with delayed pain or neurological deficits should be evaluated for intraspinal hemorrhage promptly, even when the patients had no history of direct spinal injury and had no apparent symptoms related to the spinal injury in the initial period of trauma.
Brain Injuries ; Buttocks ; Cauda Equina ; Drainage ; Hemorrhage ; Humans ; Hypesthesia ; Intracranial Hemorrhage, Traumatic ; Laminectomy ; Lumbosacral Region ; Magnetic Resonance Imaging ; Male ; Spinal Injuries ; Spine ; Subarachnoid Hemorrhage* ; Thigh

OBJECTIVETo observe treatment efficacy of acupuncture at different distal acupoints for acute lumbar sprain after massage.

METHODSOne hundred and fifty patients with acute lumbar sprain were randomly divided into a Yaotongdian (Extra) group, a Houxi (SI 3) group, a Weizhong (BL 40) group, a Chengshan (BL 57) group and a Shuigou (GV 26) group, total 5 groups, 30 cases in each one. After the same massage treatment and based on groups divided, different distal acupoints above-mentioned were selected to be acupunctured. Visual analogue scale (VAS) scores, lumbar activity and treatment efficacy of patients in 5 groups were evaluated.

RESULTSWith acupuncture at distal acupoints after massage,VAS scores of patients in 5 groups were decreased compared with those after massage treatment (all P<0.05); lumbar activity was all obviously improved (all P<0.01); and cured and markedly effective rates were all increased in comparison with those after massage (all P<0.01). But among 5 groups the differences of VAS scores, lumbar activity and cured and markedly effective rates were not statistically significant(all P>0.05).

CONCLUSIONBased on massage treatment, acupuncture at distal acupoints could further improve the treatment efficacy for acute lumbar sprain, but there is no obvious effective difference among every distal acupoint. As long as choosing acupoints with lower pain threshold and stimulating enough, good efficacy could be acquired for acute lumbar sprain.

Acupuncture Points ; Acupuncture Therapy ; Acute Disease ; therapy ; Adolescent ; Adult ; Aged ; Combined Modality Therapy ; Female ; Humans ; Lumbosacral Region ; injuries ; Male ; Massage ; Middle Aged ; Sprains and Strains ; therapy ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate the effectiveness of anterior debridement,bone graft, and posterior pedicle screw-rod internal fixation in the treatment of lumbosacral tuberculosis.

METHODSFrom January 2005 to June 2012,18 patients with lumbosacral tuberculosis undergoing the surgical treatment by anterior debridement, bone graft, and posterior pedicle screw-rod internal fixation were reviewed retrospectively. There were 12 males and 6 females with an average age of 44 years old ranging from 35 to 67. Among them, 2 cases were simple low back pain,3 cases were low back pain combined with radiating pain of lower extremity and 13 cases were muscle strength hypesthesia. According to Fankle grading,the nerve function was grade C in 3 cases,grade D in 10 cases,grade E in 5 cases. Of these cases,L4.5 was involved in 8 cases,L5 in 4 cases and L5S1 in 6 cases. The lumbosacral angle was 150 to 270 and the erythrocyte sedimentation rate (ESR) was 45 to 93 mm/h before treatment. The clinical indexes including the lumbosacral incidence, Frankel grade and ESR were reviewed at follow-up.

RESULTSAll 18 cases were followed up for 14 to 22 months. The mean operation time was 180 min. The amount of bleeding was 400 to 800 ml. Except 1 case with iliac vein injuried and 4 cases with abdominal distension,no spinal injuries and severe relative complication occurred, and neurologic function improved in various degrees. Pain in lumbosacral area and radicular pain in lower extremities disappeared. The X-ray and CT films demonstrated that bony fusion was obtained in all patients during 9 to 13 months postoperatively. The lumbosacral angle and ESR were improved significantly.

CONCLUSIONAnterior debridement, bone graft, and posterior pedicle screw-rod internal fixation is an effective method in dealing with lumbosacral spine tuberculosis.

Adult ; Aged ; Blood Loss, Surgical ; Bone Transplantation ; Debridement ; Female ; Fracture Fixation, Internal ; instrumentation ; Humans ; Lumbosacral Region ; injuries ; surgery ; Male ; Middle Aged ; Pedicle Screws ; Retrospective Studies ; Tuberculosis, Spinal ; surgery

Acupuncture Therapy ; Adult ; Female ; Humans ; Lumbosacral Region ; injuries ; Male ; Middle Aged ; Sprains and Strains ; therapy ; Young Adult

Acupuncture Therapy ; instrumentation ; methods ; Adult ; Aged ; Female ; Humans ; Lumbosacral Region ; injuries ; Male ; Middle Aged ; Muscular Diseases ; therapy ; Sprains and Strains ; therapy

Adult ; Aged ; Female ; Hip ; physiopathology ; Humans ; Knee ; physiopathology ; Lumbosacral Region ; injuries ; physiopathology ; Male ; Middle Aged ; Range of Motion, Articular ; Sprains and Strains ; physiopathology ; therapy ; Young Adult