Lumbar technique

Daniels, A. M. and R. Sallie, Headache, Lumbar Puncture, and Expectation , The Lancet 1, no. 8227 (1981) 1003 Davanloo, H., Basic Principles and Techniques in Short-Term Depression, New York S. P. Medical 8C Scientific Books, 1976 Davies, D. L. and Michael Shepherd, Reserpine in the Treatment of Anxious and Depressed Patients , The Lancet 266, no. 6881 (1955) 117-20 Davies, Sharon, Potential Conflicts of Interest More Information from Jama , British Medical Journal (2009) http / / www.bmj.com/cgi/elet-ters / 338 / feb 05 i / b463... 

The relationship between the decrease in BMD and an increased fracture risk has been widely demonstrated, in all the measured skeletal regions and by different techniques (Melton et al. 1993 Marshall et al. 1996 Cummings et al. 1993). Marshall et al. (1996) demonstrated in a metaanalysis that one standard deviation decrease in BMD in lumbar spine, hip, or proximal radius increased the risk of fracture in these locations by 50 to 60% (Fig. 8.2). A different picture is seen, however, when the effects on BMD of the different antiresorptives and their relationship with the fracture risk reduction are analyzed. 

Bakshi, A., Hunter, C., Swanger, S., Lepore, A., Fischer, I. (2004). Minimally invasive delivery of stem cells for spinal cord injury advantages of the lumbar puncture technique. JNeurosurg Spine, 1,330-7. 

The indications, rationale, techniques, alternatives, contraindications, complications, and efficacy of lumbar and caudal epidural glucocorticoid injections have been reviewed (SEDA-21, 420 452). 

Extradural (epidural) anaesthesia is used in the thoracic, lumbar and sacral (caudal) regions. Lumbar epidurals are used widely in obstetrics and low thoracic epidurals provide excellent analgesia after laparotomy. The drug is injected into the extradural space where it acts on the nerve roots. This technique is less likely to cause hypotension than spinal anaesthesia. Continuous analgesia is achieved if a local anaesthetic, often mixed with an opioid, is infused through an epidural catheter. 

Computed tomography (CT), as applied to nutrition research, was described by Kvist et ai. (198S). The technique involves exposure to X-rays for about 5 seconds, with a resulting cross-sectional picture of the abdomen called a "slice." The picture represents a "slice" of the body, where the slice is about 12 mm thick. The abdominal slice is taken at the level of one of the lumbar vertebra. The results take the form of a picture where areas of variable densities can be interpreted as being subcutaneous fat, visceral fa I, muscle, or bone. 

In 55 patients, continuous lumbar sympathetic blockade with local anesthetics administered via a catheter to treat sympathetic pain caused a psoas abscess in two patients, both of whom were treated with a continuous infusion of 0.25% bupivacaine (28). It was assumed that the catheter had been dislodged and that the drug had been injected into the psoas muscle or the psoas sheath. Another reason for this complication could have been local trauma due to a hematoma around the vertebrae during the insertion of the needle. The main drawbacks of the technique were the high incidences of infections and displacement of the catheters. 

The combination of lumbar plexus and posterior sciatic nerve block represents an alternative to a neuraxial technique. 

Determination of these compounds is carried out frequently in biological fluids. Analysis in urine requires a previous filtration to remove cells and other particulate matter then, the samples are diluted and directly injected onto the column. With cerebrospinal fluid, the samples are obtained by lumbar puncture each ahquot is centrifuged and decanted before analysis. Often in plasma or semm, some form of protein removal is needed because the presence of these compounds in injected samples can cause modifications of the column and bias in chromatographic results. Protein removal can be performed by various methods such as protein precipitation, ultrafiltra-tion, centrifugation, liquid-phase or solid-phase extraction, and column-switching techniques. 

Lidocaine hydrochloride is a local anesthetic/vasopressor preparation. Lidocaine stabilizes neuronal membranes by inhibiting the ionic fluxes required for the initiation and conduction of impulses, thereby effecting local anesthetic action. Epinephrine stimulates both alpha and beta receptors within sympathetic nervous system relaxes smooth muscle of bronchi and iris and is an antagonist of histamine. They are indicated for production of local or regional anesthesia by infiltration techniques such as percutaneous injection, by peripheral nerve block techniques such as brachial plexus and intercostals, and by central neural techniques such as lumbar and caudal epidural blocks. 

Lidocaine is indicated for production of local or regional anesthesia by the infiltration technique, and by central neural techniques such as lumbar and caudal epidural blocks. 

Szpalski, M. and Parnianpour, M. 1996. Trunk performance, strength and endurance measurement techniques and application. In S. Weisel and J. Weinstein (Eds.), The Lumbar Spine, 2nd ed., pp. 1074-1105, Philadelphia, W.B. Saunders. 

The occlusion of the iliac artery is usually sufficient to treat the leak. However, in cases of long-term type IC endoleak, many outflow vessels may have developed and the leak may communicate with multiple lumbar arteries and the IMA. These enlarged vessels might be source of late type II endoleak. Thus, we usually embolize both the outflow vessels and the sac before occluding the iliac artery. Another attractive technique to achieve the occlusion of the common iliac artery is to perform an endovascular internal to external iliac artery bypass using stentgraft. This technique can allow the exclusion of the common iliac preserving the internal iliac artery. 

Fig. 25.5 Preoperative setup is critical to successfully perform the transtibial tunnel technique. A surgeon attaches an edge of a sterile drape to his lumbar pcution and then sits beside the knee joint of the patient. The surgeon puts the patient s leg hanging beside the table on his knee covered by the drape...

The proposed technique is based on lever arm principal correction. It combines anterior rotation of the pelvis and posterior ranslation of the lumbar spine. 

Posterior distraction instrumentation as a reduction force was first used in the 1970s as a technique to provide a partial reduction and stabilization to enhance the spinal fusion. These early reports appeared to provide a satisfactory alternative to fusion in situ [4]. However, it soon became apparent that loss of lumbar lordosis was an invariable outcome of this technique, and in fact the results were often worse than the patient s original problem and complaint [7]. 

The weak point of this measurement is that it depends on one reference line which is positioned as a tangent to the posterior aspect of the first lumbar vertebral body. This reference line is very inaccurate as it is radiologically not clearly definable. Thus, it is subject to considerable variation of the measuring technique. In addition, it is possible that it is more difficult to demonstrate this measuring line after surgery, so that a reliable comparison of pre- and postoperative pictures is only possible to some extent. 

Fixator for the fixation of lower thoracic and lumbar spine fractures. The idea of external reduction for spondyloptosis was introduced by Aebi et al. [2] in four patients. In one patient this technique did not allow slip reduction and the lumbosacral kyphosis could be corrected minimally. They suggested that the External Fixator seemed to be a powerful tool allowing gradual reduction of the slip and correction of the lumbosacral kyphosis by distraction (1 mm/day). 

The largest experience to date with neurolytic thoracic and lumbar sympathetic block is in the treatment of occlusive vascular disease (Schild 1998). After sympathetic block, assessment of completeness of the interruption is best done by determining loss of sweat and a rise in skin temperature. This technique can however give rehef to patients with intractable pain caused by carcinoma, in whom conventional therapy is no longer effective (Bonica 1990b). Possible complications with thoracic sympathetic blocks include accidental puncture of the lung, puncture of intercostal vessels, or contact with the thoracic somatic nerve if the bevel... 

In lumbar sympathectomy, complications that can occur include inadvertent injection of ethanol into vessels, vertebral disks, vertebral canal, ureters, and other adjacent organs. The other major complication of chemical lumbar sympathectomy is genitofemoral neuralgia. This is caused by the diffusion of ethanol to the genitofemoral nerve as it lies on the anterior surface of the psoas muscle. These complications have been described with conventional radiologic control, but can be prevented by proper technique and precise step-by-step CT control (Kurdziel and Dondelinger 1990). 

Pedicle screw fixation for correction of spinal deformities has become the standard of care for stabilization of the thoracic and lumbar spine, where precise screw placement is essential to avoid injury to adjacent neural structures. However, the techniques currently available for planning such interventions are not optimal. Until recently, such procedures were... 

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