OBJECTIVE: To study the anatomical characteristics of blood vessels in the lateral segment of the vertebral body through the surgical approach of oblique lumbar interbody fusion (OLIF) using MRI imaging, and evaluate its potential vascular safety zone. METHODS: The lumbar MRI data of 107 patients with low back and leg pain who met the selection criteria between October 2019 and November 2022 were retrospectively analyzed. The vascular emanation angles, vascular travel angles, and the length of vessels in the lateral segments of the left vertebral body of L ₁-L ₅, as well as the distance between the segmental vessels in different Moro junctions of the vertebral body and their distances from the edges of the vertebrae in the same sequence (bottom marked as I, top as S) were measured. The gap between the large abdominal vessels and the lateral vessels of the vertebral body was set as the lateral vascular safe zones of the lumbar spine, and the extent of the safe zones (namely the area between the vessels) was measured. The anterior 1/3 of the lumbar intervertebral disc was taken as the simulated puncture center, and the area with a diameter of 22 mm around it as the simulated channel area. The proportion of vessels in the channel was further counted. In addition, the proportions of segmental vessels at L ₅ without a clear travel and with an emanation angel less than 90° were calculated. RESULTS: Except for the differences in the vascular emanation angles between L ₄ and L ₅, the vascular travel angles between L ₁, L ₂ and L ₄, L ₅, and the length of vessels in the lateral segments of the vertebral body among L ₁-L ₄ were not significant ( P>0.05), the differences in the vascular emanation angles, vascular travel angles, and the length of vessels between the rest segments were all significant ( P<0.05). There was no significant difference in the distance between vessels of L ₁, L ₂ and L ₂, L ₃ at Moro Ⅰ-Ⅳ junctions ( P>0.05), in L ₃, L ₄ and L ₄, L ₅ at Ⅱ and Ⅲ junction ( P>0.05). There was no significant difference in the vascular distance of L ₂, L ₃ between Ⅱ, Ⅲ junction and Ⅲ, Ⅳ junction, and the vascular distance of L ₃, L ₄ between Ⅰ, Ⅱ junction and Ⅲ, Ⅳ junction ( P>0.05). The vascular distance of the other adjacent vertebral bodies was significant different between different Moro junctions ( P<0.05). Except that there was no significant difference in the distance between L ₂I and L ₃S at Ⅰ, Ⅱ junction, L ₃I and L ₄S at Ⅱ, Ⅲ junction, and L ₂I and L ₃S at Ⅲ, Ⅳ junction ( P>0.05), there was significant difference of the vascular distance between the bottom of one segment and the top of the next in the other segments ( P<0.05). Comparison between junctions: Except for the L ₃S between Ⅰ, Ⅱ junction and Ⅱ, Ⅲ junction, and L ₅S between Ⅰ, Ⅱ junction and Ⅱ, Ⅲ and Ⅲ, Ⅳ junctions had no significant difference ( P>0.05), there were significant differences in the distance between the other segmental vessels and the vertebral edge of the same sequence in different Moro junctions ( P<0.05). The overall proportion of vessels in the simulated channels was 40.19% (43/107), and the proportion of vessels in L ₁ (41.12%, 44/107) and L ₅ (18.69%, 20/107) was higher than that in the other segments. The proportion of vessels in the channel of Moro zone Ⅰ (46.73%, 50/107) and zone Ⅱ (32.71%, 35/107) was higher than that in the zone Ⅲ, while no segmental vessels in L ₁ and L ₂ were found in the channel of zone Ⅲ ( χ ²=74.950, P<0.001). Moreover, 26.17% (28/107) of the segmental vessels of lateral L ₅ showed no movement, and 27.10% (29/107) vascular emanation angles of lateral L ₅ were less than 90°. CONCLUSION L ₁ and L ₅ segmental vessels are most likely to be injured in Moro zones Ⅰ and Ⅱ, and the placement of OLIF channels in L _{4, 5} at Ⅲ, Ⅳ junction should be avoided. It is usually safe to place fixation pins at the vertebral body edge on the cephalic side of the intervertebral space, but it is safer to place them on the caudal side in L _{1, 2} (Ⅰ, Ⅱ junction), L _{3, 4} (Ⅲ, Ⅳ junction), and L _{4, 5} (Ⅱ, Ⅲ, Ⅳ junctions).
Humans ; Retrospective Studies ; Spinal Puncture ; Magnetic Resonance Imaging ; Anticoagulants ; Bone Nails

OBJECTIVE: To study the clinical manifestations and treatment of intervertebral space infection after percutaneous lumbar radiofrequency ablation of nucleus pulposus. METHODS: A retrospective analysis was performed of 496 patients who underwent percutaneous lumbar disc decompression using low-temperature plasma radiofrequency ablation nucleus pulposus from June 2009 to June 2019. Six patients had lumbar infection, and the infection rate was 1.21%. All patients were male, ranging in age from 20 to 61 years old. Three patients underwent single segment radiofrequency ablation, two patients underwent dual segments ablation;and one patient underwent three segment ablation, totaling 10 intervertebral discs. One patient was complicated with type 2 diabetes before operation. The interval between infection occurrence ranged from 21 to 65 days. RESULTS: All 6 patients were followed up, and the duration ranged from 18 to 40 months, with an average of 24 months. Among them, 2 patients presented with symptoms of low back pain accompanied by fever, and imaging examination showed intervertebral space infection accompanied by abscess. In addition, 4 patients experienced low back pain but no fever, and MRI showed abnormal signals of the infected intervertebral endplate or vertebral body. One patient showed staphylococcus aureus in blood culture, while the remaining 5 patients showed negative bacterial culture. All the patients were treated with antibiotics after diagnosis. Four patients were treated with conservative management to control infection;1 patient was treated with debridement of posterior lumbar infection focus, and 1 patient was treated with debridement of posterior lumbar infection focus combined with interbody fusion and internal fixation. CONCLUSION The occurrence of intervertebral space infection during lumbar radiofrequency ablation nucleoplasty should be given sufficient attention. Strict aseptic technique, avoiding repeated multi segment puncture, realizing early detection and treatment, and selecting appropriate treatment methods according to the severity of infection is the guarantee of achieving curative effect.
Humans ; Male ; Young Adult ; Adult ; Middle Aged ; Female ; Low Back Pain ; Nucleus Pulposus ; Diabetes Mellitus, Type 2 ; Retrospective Studies ; Spinal Puncture

Headaches are a common presentation in the emergency department (ED). Even though not all are potentially serious, some such as subarachnoid hemorrhage (SAH) can be more dangerous than others. SAH is a medical emergency with an almost 50% mortality rate. It is crucial not to miss the diagnosis of SAH, as a missed or delayed diagnosis can be severely detrimental. It classically presents as thunderclap headache, a severe, sudden-onset headache. There are various approaches in diagnosing or excluding SAH, which is classically done by performing a computed tomography (CT) scan followed by a lumbar puncture (LP). But with the improved sensitivity of more modern diagnostic tools, more physicians are in support of changing this classical teaching. The aim of this case report is to review the advantages and disadvantages of LP in diagnosing SAH, along with other diagnostic tools commonly used.
Subarachnoid Hemorrhage ; Spinal Puncture ; Cerebrospinal Fluid

OBJECTIVE: To explore the clinical efficacy of percutaneous vertebroplasty(PVP) combined with nerve block in the treatment of lumbar osteoporotic vertebral compression fractures under the guidance of traditional chinese medicine "theory of equal emphasis on muscle and bone". METHODS: Total of 115 patients with lumbar osteoporotic vertebral compression fractures were treated by percutaneous vertebroplasty from January 2015 to March 2022, including 51 males and 64 females, aged 25 to 86 (60.5±15.9) years. Among them, 48 cases were treated with PVP operation combined with erector spinae block and joint block of the injured vertebral articular eminence (intervention group), and 67 cases were treated with conventional PVP operation (control group). The visual analogue scale(VAS) and Oswestry disability index(ODI) before operation, 3 days, 1 month and 6 months after operation between two groups were evaluated. The operation time, number of punctures and intraoperative bleeding between two groups were compared. RESULTS: The VAS and ODI scores of both groups improved significantly after operation compared with those before operation(P<0.05). Moreover, the VAS and ODI scores of 3 days and 1 month after operation of the intervention group improved more significantly than that of the control group(P<0.05). The difference of VAS and ODI scores before operation and 6 months after operation between two groups had no statistical significances(P>0.05). There was no statistically significant difference in the number of punctures and intraoperative bleeding between the two groups (P>0.05). CONCLUSION Based on the theory of "equal emphasis on muscles and bones", PVP combined with nerve block can effectively relieve paravertebral soft tissue spasm and other "muscle injuries", which can significantly improve short-term postoperative low back pain and lumbar spine mobility compared to conventional PVP treatment, and accelerate postoperative recovery, resulting in satisfactory clinical outcomes.
Male ; Female ; Humans ; Fractures, Compression/surgery* ; Vertebroplasty/methods* ; Spinal Fractures/surgery* ; Spinal Puncture ; Lumbar Vertebrae/injuries* ; Muscles ; Treatment Outcome ; Osteoporotic Fractures/surgery* ; Retrospective Studies ; Bone Cements

OBJECTIVE: To investigate the effects of different bone cement morphology distribution on the clinical efficacy of unilateral percutaneous vertebroplasty(PVP) for spinal osteoporotic fractures. METHODS: The clinical data of 66 patients with osteoporotic vertebral compression fractures received unilateral PVP treatment from January 2019 to April 2020 were retrospectively analyzed. There were 16 males and 50 females, including 83 vertebral bodies, 45 thoracic vertebrae and 38 lumbar vertebrae, and 55 patients with single-segment, 6 double-segment, 4 three-segment and 1 four-segment. The age ranged from 60 to 93 years with an average of (76.83±8.65) years. The included patients were admitted to hospital 1 to 10 days after onset, and were diagnosed by anteroposterior and lateral X-rays, MRI and bone density examination before surgery. According to the shape of bone cement in postoperative X-ray, the patients were divided into O-shaped group (28 cases) and H-shaped group (38 cases). In O-shaped group, the bone cement presented agglomeration mass distribution in the affected vertebra in postoperative X-ray while the bone cement presented disseminated honeycomb distribution in the affected vertebrae in H-shaped group. Bone cement injection volume was collected in two groups. The intraoperative bone cement leakage and postoperative adjacent vertebral fractures were observed. The VAS of the two groups before operation and 1 day, 1 month, 6 months and 1 year after operation were compared;and ODI of the two groups 1 day, 6 months and 1 year after operation were compared. The kyphosis angle and anterior height of the affected vertebrae were measured before operation and 1 week, 1 year after operation. RESULTS: All 66 patients completed 1-year follow-up, and all patients healed well at the puncture site after surgery. There were 1 case and 8 cases of bone cement leakage in O-shaped group and H-shaped group during surgery respectively (P<0.05), but no serious complications occurred. One case occurred adjacent vertebral fracture in both groups during one-year follow-up (P>0.05). There was no statistical significance in injection amount of bone cement between the two groups (P>0.05). The VAS scores of O-shaped group and H-shaped group were 7.89±0.79, 2.75±1.08, 0.46±0.58, 0.36±0.49 and 8.00±1.04, 2.58±1.15, 0.53±0.56, 0.42±0.50 before operation, 1 day, 6 months, 1 year after operation respectively, and there was no statistical significance(P>0.05), and the VAS scores were 0.96±0.58 and 1.18±0.83 at 1 month after operation respectively, with statistical significance(P<0.05). The ODI scores of O-shaped group and H-shaped group were 12.43±3.78, 10.00±2.46, 8.43±1.50 and 12.11±3.68, 9.53±2.35, 8.32±1.51 at 1 day, 6 months and 1 year after surgery respectively, and there was no statistical significance between the two groups(P>0.05). There were no statistical significance in kyphotic angles and anterior height before surgery and 1 week, 1 year after surgery between two groups (P>0.05). CONCLUSION No matter the distribution of bone cement is O-shape or H-shape, it can achieve good clinical effect, and the prognosis effect is equivalent. Therefore, when performing unilateral puncture PVP surgery, it is not necessary to deliberately increase the puncture angle of the puncture needle in order to achieve the full diffusion of the affected vertebrae, so as to reduce the risk of damaging important structures and bone cement leakage.
Aged ; Aged, 80 and over ; Bone Cements/therapeutic use* ; Female ; Fractures, Compression/surgery* ; Humans ; Kyphosis ; Male ; Middle Aged ; Osteoporotic Fractures/surgery* ; Retrospective Studies ; Spinal Fractures/surgery* ; Spinal Puncture ; Treatment Outcome ; Vertebroplasty

OBJECTIVE: To assess the analgesic efficacy of compound lidocaine cream in lumbar puncture of children with leukemia and lymphoma. METHODS: 312 leukemia and lymphoma children necessarily undergone lumbar puncture were divided into compound lidocaine cream (cream) group and compound lidocaine injection (injation) group as control with 156 cases respectively according to the will of inpatient children and their family. For cream group, compound lidocaine cream was smeared on the skin around the lumbar puncture point evenly and covered with sterile and transparent dressing for about one hour before lumbar puncture. Then the cream and transparent dressing were removed and lumbar puncture was performed after regular disinfection. For control group, 2% compound lidocaine was injected as local anesthesia before lumbar puncture. The extent of pain was evaluated by Wong-Baker Faces Pain Rating Scale and FLACC Scale as well as children's physiological indexes (heart rate, breathing, blood pressure). The lumbar puncture success rate and the discomfortableness as well as family satisfaction were recorded by special person. RESULTS: Compared with control group, the incidence of pain and discomfortableness in cream group significantly reduced, and the family satisfaction significantly increased (P＜0.05). There were obviously differences in the physiological indexes (heart rate, breathing, systolic blood pressure) before and after lumbar puncture in control group (P＜0.05). However, the physiological indexes in cream group had no obvious change. There was no difference on the success rate of lumbar puncture between the two methods of anesthesia. CONCLUSION Compound lidocaine cream has significantly analgesic effect which can relieving pain caused by lumbar puncture for children.
Analgesics ; Anesthetics, Local ; Child ; Hematologic Neoplasms ; Humans ; Lidocaine ; Lidocaine, Prilocaine Drug Combination ; Spinal Puncture

PURPOSE: We report an unusual case of Leber hereditary optic neuropathy presenting with optic disc hyperfluorescence. CASE SUMMARY: A 17-year-old male with sequential painless visual loss 3 weeks apart affecting first the left and then the right eye presented to our neuro-ophthalmology clinic. His best-corrected visual acuity was counting fingers in the right eye and 0.32 in the left eye. Fundus examination showed mild optic disc edema and hyperemia in both eyes, which were worse in the right eye. Fluorescein angiography revealed dye leakage from the right optic disc in the late phase. The results of magnetic resonance imaging of the brain and spinal cord were normal, and lumbar puncture study was unremarkable. Mitochondrial DNA sequencing revealed a pathognomonic 11778 mutation for Leber hereditary optic neuropathy. His vision deteriorated to 0.03 in both eyes 6 months later, but slowly started to improve 11 months after onset. At 2 years, his corrected visual acuity was 0.2 in both eyes. CONCLUSIONS: To our knowledge, this is the first report of optic disc hyperfluorescence in Leber hereditary optic neuropathy. This finding suggests that this mitochondrial optic neuropathy can masquerade as optic neuritis.
Adolescent ; Brain ; DNA, Mitochondrial ; Edema ; Fingers ; Fluorescein Angiography ; Humans ; Hyperemia ; Magnetic Resonance Imaging ; Male ; Optic Atrophy ; Optic Atrophy, Hereditary, Leber ; Optic Nerve Diseases ; Optic Neuritis ; Spinal Cord ; Spinal Puncture ; Visual Acuity

OBJECTIVE: This study was conducted to identify the characteristics of early infants with urinary tract infection (UTI) who visited the pediatric emergency department (PED) and to investigate the characteristics of patients with cerebrospinal fluid (CSF) pleocytosis and incidence of bacterial meningitis. METHODS: We retrospectively reviewed the records of UTI infants aged 31 to 90 days presenting at PED whom had lumbar puncture. From September 1, 2014 to August 31, 2017, a total of 225 infants were enrolled. RESULTS: Twenty three patients had CSF pleocytosis. Of these, two patients were positive for CSF enteroviral polymerase chain reaction, while none were positive for bacterial culture. We compared the characteristics of infants with CSF pleocystosis. There were not diffences in sex, vaccination before fever, general condition, peak body temperature, peripheral white blood cell, C-reactive protein, and procalcitonin between two groups. However, in patients with prematurity history, incidence of CSF pleocytosis was high. Four infants hot bacteremia, and organism of these patients was all Escherichia coli. All of them had negative CSF culture and normal CSF findings. CONCLUSION: No febrile early infants with UTI had bacterial meningitis. As a result, we must not do conventional test of CSF in patients with UTI.
Bacteremia ; Body Temperature ; C-Reactive Protein ; Cerebrospinal Fluid ; Emergencies ; Emergency Service, Hospital ; Escherichia coli ; Fever ; Humans ; Incidence ; Infant ; Leukocytes ; Leukocytosis ; Meningitis ; Meningitis, Bacterial ; Polymerase Chain Reaction ; Retrospective Studies ; Spinal Puncture ; Urinary Tract Infections ; Urinary Tract ; Vaccination

OBJECTIVE: This study examined the characteristics of febrile young infants with a serious bacterial infection (SBI) who visited emergency centers in Korea and validated the Philadelphia criteria and modified Philadelphia criteria to predict the risk of SBI. METHODS: This was a retrospective study conducted on 450 infants aged 31 days to 56 days who visited three emergency centers with fever from September 2014 to August 2017. The characteristics of the SBI patients were analyzed, and the validation of the Philadelphia and modified Philadelphia criteria sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were checked. RESULTS: Of 450 patients, 165 patients (36.7%) had SBI, such as urinary tract infection (33.3%), bacteremia (4.0%), acute osteomyelitis (0.2%), and bacterial meningitis (BM) in two patients (0.4%). The most common pathogen of invasive bacterial infection was Escherichia coli. In the Philadelphia criteria, the sensitivity, specificity, PPV, NPV, and accuracy were 73.9%, 47.0%, 44.7%, 75.7%, and 56.9%, respectively. In the modified Philadelphia criteria that excluded lumbar puncture as a predictor, the sensitivity, specificity, PPV, NPV, and accuracy were 93.3%, 31.9%, 44.3%, 89.2%, and 54.4%, respectively. The most common failed low risk criteria was appearance (43.3%). Two patients with bacterial meningitis were excluded from low risk group by the modified Philadelphia criteria. Although one out of 2 patients met the failed low risk criteria due to their poor condition, this factor is not objective, so BM can be missed. CONCLUSION: Bacterial meningitis was too rare in this study. New criteria are needed to predict SBI. The Philadelphia and modified Philadelphia criteria were not useful for predicting SBI in this study. Other prediction models will be needed to predict SBI in the vaccination era.
Bacteremia ; Bacterial Infections ; Emergencies ; Emergency Service, Hospital ; Escherichia coli ; Fever ; Fibrinogen ; Humans ; Infant ; Korea ; Meningitis ; Meningitis, Bacterial ; Osteomyelitis ; Retrospective Studies ; Sensitivity and Specificity ; Spinal Puncture ; Urinary Tract Infections ; Vaccination

Most cases of spinal subdural hematoma are very rare and result from iatrogenic causes, such as coagulopathy or a spinal puncture. Cases of non-traumatic spinal subdural hematoma accompanied by intracranial hemorrhage are even more rare. There are a few reports of spontaneous spinal subdural hematoma with concomitant intracranial subdural or subarachnoid hemorrhage, but not with intracerebral hemorrhage. Especially in our case, the evaluation and diagnosis were delayed because the spontaneous intracerebral hemorrhage accompanying the unilateral spinal subdural and subarachnoid hemorrhages caused hemiplegia. We report a case of spinal subdural and subarachnoid hemorrhage with concomitant intracerebral hemorrhage, for the first time, with a relevant literature review.
Cerebral Hemorrhage ; Diagnosis ; Hematoma ; Hematoma, Subdural, Spinal ; Hemiplegia ; Intracranial Hemorrhages ; Spinal Puncture ; Subarachnoid Hemorrhage