Myelomeningocele: need for long-time complex follow-up—an observational study

The purpose of this study was to describe the relationship between pelvic inclination (PI) and lumbar lordosis (LL). Pelvic inclination and pelvic tilt are two different names for the same metric. The geometrical parameters of the spine and pelvis were measured using surface topography scanning, and the data was explored for any physical relationships using principal component analysis. Once widely assumed to be a direct correlation, research in the 1980s first cast doubt upon the PI to LL relationship. And yet, other studies have suggested a relationship does exist. Decades later, the rehabilitation professionals often still rely on this supposed correlation when making decisions about rehabilitation treatment interventions. This theoretical relationship requires further clarification, which is explored herein. Surface topography imaging is a technology that has proven to be a radiation-free way to produce accurate, reliable skeletal alignment measures. Patient data from one physical rehabilitation clinic was collected at the time of initial assessment. Patients presented with a wide range of musculoskeletal complaints. Surface topography scans were performed on 107 patients at the commencement and completion of their therapy. Principal component analysis was performed on the collected data to determine how these spine and pelvic alignment parameters changed between the two points in time and what trends and/or relationships exist between the parameters. Our analysis evaluated eight spinal and pelvic measurements as input and focused on LL and PI as the two principal components at time points of beginning and completion of treatment. Pelvic inclination and lumbar lordosis changed during treatment but were not correlated. Our data demonstrates that pelvic inclination and lumbar lordosis do not have a predictable relationship as previously assumed.     

Lumbar collaterals of neurons of the C6 segment projecting to sacral segments of the cat spinal cord

Electrophysiological investigations of neurons of the C6 segment of the spinal cord were made in α-chloralose anesthetized animals. It was established in the experiments that a part of long descending propriospinal neurons originating in the sixth cervical segment (C6) that projected to sacral segments (S1/S2) gave off collateral branches at the level of the fourth lumbar segment (L4). Several types of neurons were distinguished according to the ipsilateral, contralateral or bilateral course of axons at the thoracic level as well as their lumbar or sacral projections. The cell bodies of 58 identified neurons were distributed in Rexed's laminae VII and VIII of the gray matter. Axons descended in lateral funiculi and their conduction velocities varied from 50 to 85 m/s. The existence of collaterals to various segments of the lumbosacral enlargement indicates that the same information conveyed by long descending propriospinal neurons can reach separate motor centers controlling various muscles of the hindlimbs.     

Studies on the sex-specificity of the human spinal profile

The findings presented in this paper demonstrate that sex-specific growth results in a more steeply inclined Os sacrum and higher abdomen in females than in males, a fact which might be connected with women's child-bearing function. Moreover, the female spinal column is situated more closely around a statically favourable central body-perpendicular. Both the inclination of the Os sacrum and the central position of the spine, must result in a stronger lumbar lordosis.     

Differences on spinal curvature in standing position by gender, age and weight status using a noninvasive method

This aim was to examine differences on lumbar lordosis and thoracic kyphosis in standing position by gender, age and weight status in healthy subjects using a noninvasive method. A total of 297 women (36.6 ± 7.3 years) and 362 men (39.8 ± 7.5 years) participated in this study. Participants were categorized according to the international BMI (kg/m2) cut-off points. Age was stratified by ten years increments starting from 20 y. Men showed smaller lumbar lordosis (17.3 ± 9.3) and larger thoracic kyphosis (42.8 ± 8.8°) than women (29.6 ± 11.3 and 40.4 ± 9.5° respectively; both p < .001). Older groups presented smaller lumbar lordosis and larger thoracic kyphosis values compared with the 20-29 y group (20.9 ± 10.4, 20.8 ± 11.2 and 23.6 ± 12.6° for ≥ 50, 40-49 and 30-39 y, respectively vs. 26.7 ± 12.2° for 20-29 y in lumbar lordosis and 42.6 ± 9.8, 42.61 ± 8.7 and 41.8 ± 8.9° for ≥ 50, 40-49 and 30-39 y, respectively vs. 37.5 ± 10.9° for 20-29 y in thoracic kyphosis; both p < .05). Finally, overweight and obese groups showed smaller lumbar lordosis (19.4 ± 11.1 and 20.9 ± 11.8° respectively) and larger thoracic kyphosis values (42.7 ± 8.9 and 42.8 ± 9.4° respectively) compared with nonoverweight participants (25.1 ± 12.4 and 40.6 ± 9.2° for lumbar lordosis and thoracic kyphosis respectively; all p < .05). However, when gender, age and weight status were take into account all together only gender seems to influence the lumbar lordosis curvature. The results of this study suggest that gender could be the only determinant factor of lumbar lordosis in healthy people.     

Age-Related Loss of Lumbar Spinal Lordosis and Mobility – A Study of 323 Asymptomatic Volunteers

Background

The understanding of the individual shape and mobility of the lumbar spine are key factors for the prevention and treatment of low back pain. The influence of age and sex on the total lumbar lordosis and the range of motion as well as on different lumbar sub-regions (lower, middle and upper lordosis) in asymptomatic subjects still merits discussion, since it is essential for patient-specific treatment and evidence-based distinction between painful degenerative pathologies and asymptomatic aging.

Methods and Findings

A novel non-invasive measuring system was used to assess the total and local lumbar shape and its mobility of 323 asymptomatic volunteers (age: 20–75 yrs; BMI <26.0 kg/m²; males/females: 139/184). The lumbar lordosis for standing and the range of motion for maximal upper body flexion (RoF) and extension (RoE) were determined. The total lordosis was significantly reduced by approximately 20%, the RoF by 12% and the RoE by 31% in the oldest (>50 yrs) compared to the youngest age cohort (20–29 yrs). Locally, these decreases mostly occurred in the middle part of the lordosis and less towards the lumbo-sacral and thoraco-lumbar transitions. The sex only affected the RoE.

Conclusions

During aging, the lower lumbar spine retains its lordosis and mobility, whereas the middle part flattens and becomes less mobile. These findings lay the ground for a better understanding of the incidence of level- and age-dependent spinal disorders, and may have important implications for the clinical long-term success of different surgical interventions.     

Method of prolonged perfusion of the spinal cord central canal in the adult cat in vivo in neurophysiological studies

A method for in-vivo long-lasting perfusion of the central canal of the cat lumbosacral spinal cord with artificial cerebrospinal fluid is described. The method provides for a stable continuous flow of perfusion fluid for many hours. The perfusion adjustment does not entail any injuries to the inferior lumbar and sacral segments of the spinal cord or their roots.     

Evolution of the lumbosacral angle

The lumbosacral angle (LSA) was studied in 131 children ranging in age from birth to 5 years. This angle increases from an average of 20 degrees at birth to an average of 70 degrees at the age of 5 years; it remains at that level thereafter. This study demonstrates that the formation of the LSA is not related to increasing age, height, or weight. Nor do obstetrical requirements seems to play any major role in the formation of the lumbosacral angle. Rather, it appears that the development of the LSA is related to the progressive acquisition of erect posture and the ontogeny of bipedal locomotion. This angle is almost nil in the nonprimate mammals (who only infrequently stand erect). It is minimal in monkeys who occasionally assume bipedal postures and increases somewhat in living apes who engage in facultative bipedal positional behavior. In the early australopithecines, the LSA is increased over that in apes, and it reaches its maximum in Homo sapiens. Deviations from normal and healthy erect posture in Homo sapiens result in corresponding changes in the lumbosacral angle. Lumbar and sacral angles (both forming the lumbosacral angle) are almost equal in all mammalian species. Since the sacral angle of Australopithecus afarensis is approximately 15 degrees, it can be implied that its lumbosacral angle was small, thus attesting to its "imperfect" erect posture and "primitive" form of bipedal locomotion.     

High assimilation of the sacrum in a sample of American skeletons: Prevalence,pelvic size,and obstetrical and evolutionary implications

High assimilation sacrum is fusion of the caudal‐most lumbar vertebra to the first sacral vertebra. Previous studies have shown that high assimilation is associated with clinical problems, including obstetrical difficulty. This study used adult American males (n = 1,048) and females (n = 1,038) of the Hamann–Todd and Terry skeletal collections to determine the prevalence of high assimilation and its effect on pelvic size, and to consider the obstetrical and evolutionary implications of high assimilation. The prevalence of high assimilation in this sample is 6.3%, with males and females not differing significantly from one another in their prevalence. This prevalence is near the median for that reported in 41 other samples. In both males and females, individuals with high assimilation have significantly longer anteroposterior and posterior sagittal diameters of the inlet, and shorter sacrum compared to those with a nonassimilated sacrum. Females with high assimilation have a significantly narrower sacral angulation (i.e., reduced inclination of ventral axis of sacrum), and shorter posterior sagittal diameter of the outlet compared to those with a nonassimilated sacrum. A short posterior sagittal diameter of the outlet is associated with childbirth difficulty. As high assimilation is partial homeotic transformation of a lumbar vertebra, this study supports previous research that homeotic transformation of vertebrae is selectively disadvantageous. Am J Phys Anthropol, 2009. © 2008 Wiley‐Liss, Inc.     

Bisexual behavior in the male rat: Influence of masculine sexual activity on the display of lordosis behavior

Sexually inexperienced male Wistar rats (strain WI in our colony) known to very infrequently display spontaneous lordosis behavior (Schaeffer et al., 1990b) were used. A first group was tested four times at 5-day intervals for lordosis with vigorous stimulus males (heterotypic sexual behavior), immediately following testing for masculine sexual activity with highly receptive females (homotypic sexual behavior). A small number of animals displayed lordosis during the first test, but more and more animals displayed this behavior from the first to the fourth test. There was no relationship between the degree of masculine sexual activity--intromission without ejaculation or ejaculation--and the occurrence of lordosis behavior. A second group was tested only once for both masculine sexual activity and lordosis behavior as above and afterwards three times at 5-day intervals for lordosis behavior in the absence of any previous testing for masculine sexual activity. A few animals displayed lordosis during their first test. As compared to the first group, the animals which had not displayed lordosis in the first test never showed lordosis responses in the following tests. It is concluded that both homotypic and heterotypic sexual interactions are required for the display of lordosis behavior in the strain of Wistar rats used in this study.     

Evolution of the sacrum in hominoids

In order to study the formation of the sacrum during the primate evolution, a new way of numbering mammalian vertebrae is presented; this demonstrates that the thoracolumbosacral complex is fixed at 22 vertebrae in 80% and at 22 +/- 1 in 100% of the cases. The shift of a vertebra from one type to another occurs either at the thoracolumbar or at the lumbosacral junction and not at the cervicothoracic junction. Rarely does the shift take place at the sacrococcygeal junction. Data from 318 primates reveal that the seven original lumbar vertebrae of the Old World monkeys are reduced in the great apes by a caudad "thoracization" of one to two lumbar vertebrae and a cephalad sacralization of one to four lumbar vertebrae. In the apes, sacralization is not total and different stages that are intermediate between lumbar and sacral are described. In Homo sapiens there is a total sacralization of the last two original lumbar vertebrae. In addition, development of the sacral wings (alae) is minimal in apes and reaches its maximum in hominids. The tendency of the hominoid sacrum to incorporate the last lumbar vertebrae and to widen markedly provides for an enhanced articulation of the sacrum with the ilium and offers a firm base of support for the trunk during erect posture. This is necessary for the support of the weight of the trunk above the sacrum and for the stabilization of the body during bipedal posture and locomotion. Encephalization did not play any major role in the widening of the sacrum since the former by far preceded the latter.     

How do we stand? Variations during repeated standing phases of asymptomatic subjects and low back pain patients

An irreproducible standing posture can lead to mis-interpretation of radiological measurements, wrong diagnoses and possibly unnecessary treatment. This study aimed to evaluate the differences in lumbar lordosis and sacrum orientation in six repetitive upright standing postures of 353 asymptomatic subjects (including 332 non-athletes and 21 athletes – soccer players) and 83 low back pain (LBP) patients using a non-invasive back-shape measurement device.In the standing position, all investigated cohorts displayed a large inter-subject variability in sacrum orientation (∼40°) and lumbar lordosis (∼53°). In the asymptomatic cohort (non-athletes), 51% of the subjects showed variations in lumbar lordosis of 10–20% in six repeated standing phases and 29% showed variations of even more than 20%. In the sacrum orientation, 53% of all asymptomatic subjects revealed variations of >20% and 31% of even more than 30%.It can be concluded that standing is highly individual and poorly reproducible. The reproducibility was independent of age, gender, body height and weight. LBP patients and athletes showed a similar variability as the asymptomatic cohort. The number of standing phases performed showed no positive effect on the reproducibility. Therefore, the variability in standing is not predictable but random, and thus does not reflect an individual specific behavioral pattern which can be reduced, for example, by repeated standing phases.     

Measurement of spinal sagittal curvatures using the laser triangulation method

The purpose of the first part of the study was to establish the variability of repeated measurements in different measuring conditions. In the second part, we performed in a large number of patients, a measurement of thoracic kyphosis and lumbar lordosis and compared them to age, gender, and level of nourishment. In the first part, measurements were performed on a plastic model of the back of a patient with a rigid and a normal spine. In the second part, 250 patients participated in the study (126 men and 124 women). For measuring spinal curvatures we used an apparatus for laser triangulation constructed at the Faculty of Mechanical Engineering, University of Ljubljana. A comparison of 30 repeated measurements was shown as the average value +/- 2 SD which included 95% of the results. Thirty repeated readings of one 3D measurement: thoracic kyphosis 41.2 degrees +/- 0.6 degrees, lumbar lordosis 4.4 degrees +/- 1.2 degrees; 30 measurements on a plastic model: thoracic kyphosis 36.8 degrees +/- 1.2 degrees, lumbar lordosis 30.9 degrees +/- 2.0 degrees; 30 measurements on a patient with a rigid spine: thoracic kyphosis 41.5 degrees +/- 2.4 degrees, lumbar lordosis 4.0 degrees +/- 1.8 degrees; 30 measurements on a patient with a normal spine: thoracic kyphosis 48.8 degrees +/- 7.4 degrees, lumbar lordosis 21.1 degrees +/- 4.4 degrees. The average size of thoracic kyphosis in 250 patients was 46.8 degrees (SD 10.1 degrees) and lumbar lordosis 31.7 degrees (SD 12.5 degrees). The angle size was statistically significantly correlated to gender (increased thoracic kyphosis and lumbar lordosis in women) and body mass index (increased thoracic kyphosis and lumbar lordosis in more nourished patients). Age was not significantly correlated to the observed angles. During measurements of the spinal angles it was important to pay attention to relaxation and the patient's position as well as to perform more measurements providing the average value. The age and the level of nourishment influence the size of the sagittal spinal angles. In the observed sample the effect of age was not confirmed.     

Lumbar portion of the human spinal canal at different age periods

The investigation was performed in 253 lumbosacral parts of the spinal column in fetuses, children and adult men in order to study age dynamics of the vertebral canal both at the level of the vertebra and at the level of the intervertebral disks. For the first time reliable data were obtained on dimentions of sagittal and frontal diameters of the canal at the lumbar level in practically healthy persons of different age. "Vertical comparison" of mean values of these parameters gave information on the character of spatial reaction of the canal dimentions and its form at various levels and demonstrated age peculiarities of these relations. In persons at the age of 22-74 years in vertibral segments of the lumbar part of the spinal column certain degenerative-destructive processes were revealed; they could affect the size and form of the canal. The rate, level and degree of these processes were demonstrated to vary in different age periods.     

Spondylolysis, spondylolisthesis, and lumbo-sacral morphology in a medieval English skeletal population

The prevalence of spondylolysis and spondylolisthesis was studied in an adult skeletal series from a rural English medieval archaeological site. Attempts were made to evaluate the association of three aspects of lumbo-sacral skeletal morphology (pelvic incidence (a measure of the anterior inclination of the sacral table), lumbar transverse process width, and the presence of lumbo-sacral spina bifida occulta) with spondylolysis and spondylolisthesis. Results indicated a high prevalence of spondylolysis compared with a modern reference population, but few cases of spondylolisthesis were identified. Analysis of prevalence with respect to age suggests that in the study population, pars interarticularis defects generally formed late in the growth period or early in adult life. The study group showed a high mean pelvic incidence compared with modern Western Europeans, indicating a more steeply inclined sacral table, which may have elevated the risk of developing pars interarticularis defects. However, no statistically valid association could be demonstrated between the presence/absence of spondylolysis and pelvic incidence in the study material. There was no evidence for a link between lumbar transverse process index or lumbo-sacral spina bifida occulta and spondylolysis/spondylolisthesis. It is concluded that the potential role of lumbo-sacral morphology, as well as of activity regimes, should be considered when interpreting spondylolysis in paleopathological studies. If the frequency of spondylolysis is to some extent an indicator of past activity regimes, it may reflect lifestyle in younger individuals rather than in mature adults. Further work investigating the link between spondylolysis and lumbo-sacral morphological variables in premodern populations would be of value.     

Prediction of biomechanical parameters in the lumbar spine during static sagittal plane lifting.

A combined approach involving optimization and the finite element technique was used to predict biomechanical parameters in the lumbar spine during static lifting in the sagittal plane. Forces in muscle fascicles of the lumbar region were first predicted using an optimization-based force model including the entire lumbar spine. These muscle forces as well as the distributed upper body weight and the lifted load were then applied to a three-dimensional finite element model of the thoracolumbar spine and rib cage to predict deformation, the intradiskal pressure, strains, stresses, and load transfer paths in the spine. The predicted intradiskal pressures in the L3-4 disk at the most deviated from the in vivo measurements by 8.2 percent for the four lifting cases analyzed. The lumbosacral joint flexed, while the other lumbar joints extended for all of the four lifting cases studied (rotation of a joint is the relative rotation between its two vertebral bodies). High stresses were predicted in the posterolateral regions of the endplates and at the junctions of the pedicles and vertebral bodies. High interlaminar shear stresses were found in the posterolateral regions of the lumbar disks. While the facet joints of the upper two lumbar segments did not transmit any load, the facet joints of the lower two lumbar segments experienced significant loads. The ligaments of all lumbar motion segments except the lumbosacral junction provided only marginal moments. The limitations of the current model and possible improvements are discussed.     

Correlation of kidney weight and volume and selected skeletal parameters to sex in the adult rhesus monkey (Macaca mulatta)

This report outlines a comparison of renal weight and volume and selected skeletal parameters to sex in 22 adult male and 156 adult female rhesus macaques. Means and standard deviations for kidney weight and volume, body weight, and radiographic measurements for both males and females are reported. Ninety-five percent confidence intervals and P-values for the mean differences between the sexes for these parameters were also compiled. Male monkeys were larger, but had kidneys of similar size to those of the females. Joint distributions of the radiographic measurements of the first lumbar vertebra and the skull showed that males were larger in both measurements. The distributions of these parameters were clearly separate in males and females, while joint distributions of kidney weight and volume for males and females overlapped almost completely. We found that, regardless of age, sex, weight, or skeletal size, all normal adult rhesus monkeys generally have similar-sized kidneys.     

The Effect of the Inclination of the Pelvic Brim and the Shape and Inclination of the Upper Sacrum on the Passage of the Head through the Upper Pelvis: (Section of Obstetrics and Gynæcology)

Engagement of the Head does not depend only on the size and shape of the brim, but also on the angle of inclination of the brim. The methods of determining this inclination are considered and the angle between the plane of the brim and the front of the body of the 5th lumbar vertebra is found to furnish the best index of the inclination. Analysis of a series of cases shows that this angle varies considerably. Its postural range is demonstrated.When the inclination is high the head does not easily engage although the measurements may be normal, and a high inclination is one of the commonest causes of unexpected dystocia.Because these cases are usually selected for a "trial of labour", criteria are necessary to select the cases suitable. Success or failure of trial labour in these cases depends on the amount of room in the upper pelvis. A part from the actual size of the true conjugate the amount of room is shown to depend both on the sacral inclination, a method of measuring which is described, and the shape of the upper sacrum, which shows considerable vriation. A common type of pelvis causing dystocia is one in which the inclination of the brim is high and the upper sacrum is relatively vertical and convex. Pelves of this type do not always fit into any of the standard classifications.The uses and limitations of postural treatment of these cases are discussed.     

Immunohistochemical, Histochemical and Radioassay Analysis of Nitric Oxide Synthase Immunoreactivity in the Lumbar and Sacral Dorsal Root Ganglia of the Dog

Summary In this study, immunohistochemistry for neuronal nitric oxide synthase (bNOS-IR), nicotinamide adenine dinucleotide phosphate diaphorase histochemistry (NADPHd) and nitric oxide synthase radioassay were used to study the occurrence, number and distribution pattern of nitric oxide synthesizing neurons in the lumbar (L1–L7) and sacral (S1–S3) dorsal root ganglia of the dog. Nitric oxide synthase immunolabelling was present in a large number of small- (area <1000 μm²) and medium-sized (area 1000–2000 μm²) as well as in a limited number of large-sized (area >2000 μm²) neurons. Although neuronal nitric oxide synthase immunolabelling and histochemical staining provided intense staining of multiple small- and medium-sized neurons in all lumbar and sacral dorsal root ganglia, immunolabelled or histochemically stained somata exhibited little topographic distribution in individual dorsal root ganglia. Great heterogeneity was noticed in the immunolabelling of medium-sized nitric oxide synthase immunopositive neurons ranging from lightly immunolabelled somata to heavily immunoreactive ones with completely obscured nuclei. Both staining procedures proved to be highly effective in visualizing intraganglionic fibers of various diameters. In general, the largest fibers revealed at the peripheral end of lumbar and sacral dorsal root ganglia were larger, 6.49–9.35 μm in diameter, while those running centrally and proceeding into the dorsal roots were about 30% reduced, ranging between 5.32 and 8.67 μm in diameter. Peripherally, the occurrence of nitric oxide synthase detected in axonal profiles, and confirmed histochemically, in the specimens of the femoral and sciatic nerves, is the first indication of the presence of nitric oxide synthase in the peripheral processes of somata located in L4–S2 dorsal root ganglia. Large and thin central nitric oxide synthase immunoreactive processes of L1–S3 dorsal root ganglion neurons segregate shortly before entering the spinal cord, the former making a massive medial bundle in the dorsal root accompanied by a slim lateral bundle penetrating Lissauer's tract. Quantitative assessment of the distribution of bNOS-IR and/or NADPHd-stained neurons showed a peculiar pattern in relation to spinal levels. Apparent incongruity was found in the total number of NADPHd-stained versus bNOS-IR neurons, demonstrating a clear prevalence of small bNOS-IR somata in all lumbar ganglia, while medium-sized NADPHd-stained somata clearly prevailed all along the rostrocaudal axis with a peak in L5 ganglion. While the number of small bNOS-IR neurons clearly outnumbered NADPHd-stained and NADPHd-unstained somata in S1–S3 ganglia, an inverse relation appeared comparing the total number of medium-sized NADPHd-stained and NADPHd-unstained somata compared with the number of moderate and intense bNOS-IR neurons. Densitometry of bNOS-IR and NADPHd-stained neurons in lumbar and sacral ganglia revealed two distinct subsets of densitometric profiles, one relating to more often found medium-sized bNOS immunolabelled and the other, characteristic for moderately bNOS immunoreactive somata of the same cell size. Considerable differences in catalytic nitric oxide synthase activity, determined by conversion of [³H]arginine to [³H]citrulline were obtained in lumbosacral dorsal root ganglia all along the lumbosacral intumescence, the lowest (0.898± 0.2 dpm/min/μg protein) being in the L4 dorsal root ganglion and the highest (4.194± 0.2 dpm/min/μg protein) in the S2 dorsal root ganglion.