Morphological Design and Study of a 3D Printed Integrated Fusion Device Based on CT Measurement Data Assisted Anterior Lumbosacral Spine / Diseño Morfológico y Estudio de un Dispositivo de Fusión Integrado Impreso en 3D Basado en Datos de Medición de TC Asistida de Columna Lumbosacra Anterior

SUMMARY: To measure and study the anatomical morphological data of the lumbar 5 to sacral 1 intervertebral space with the aid of CT and design an anatomical anterior lumbosacral 3D printed integrated interbody fusion for the treatment of degenerative lumbosacral spine diseases. 100 adults (50 of each sex) who underwent CT examination of the lumbar spine in our hospital were selected, and their lumbar 5 to sacral 1 intervertebral space anatomical data were measured, including the anterior lumbar convexity angle, different sagittal and coronal heights, and the sagittal and coronal diameters of the superior and inferior endplates. The measured data were also statistically analyzed, and morphological design and study of the 3D printed integrated fusion device in the anterior lumbosacral spine was performed by applying computer software. When comparing the coronal and sagittal diameters of the superior and inferior endplates from lumbar 5 to sacral 1, the differences were statistically greater in men than in women (P0.001). When comparing the height at different positions in the median sagittal plane, both males and females showed an anterior high and posterior low pattern. In the coronal plane, both males and females showed the highest height in the middle position (P0.001). CT can measure the anatomical data of the lumbosacral spinal hiatus more accurately. The 3D-printed anterior integrated fusion device of the lumbosacral spine designed according to the analysis of the data results is more in line with the anatomical structure of the lumbosacral spine, fits well with the superior and inferior endplates, and effectively restores the height and anterior convexity angle of the lumbosacral space.

El objetivo de este trabajo fue medir y estudiar los datos morfológicos anatómicos del espacio intervertebral lumbar 5 a sacro 1 con la ayuda de TC y diseñar una fusión intersomática integrada anatómica lumbosacra anterior impresa en 3D para el tratamiento de enfermedades degenerativas de la columna lumbosacra. Se seleccionaron en nuestro hospital 100 adultos (50 de cada sexo) que se sometieron a un examen de TC de la columna lumbar y se midieron los datos anatómicos del espacio intervertebral lumbar 5 al sacro 1, incluyendo el ángulo de la convexidad lumbar anterior, diferentes alturas sagital y coronal, y los diámetros sagital y coronal de las placas terminales superior e inferior. Los datos medidos también se analizaron estadísticamente y se realizó el diseño morfológico y el estudio del dispositivo de fusión integrado impreso en 3D en la columna lumbosacra anterior mediante la aplicación de software informático. Al comparar los diámetros coronal y sagital de las placas terminales superior e inferior desde lumbar 5 hasta sacro 1, las diferencias fueron estadísticamente mayores en hombres que en mujeres (P 0,001). Al comparar la altura en diferentes posiciones en el plano mediano, tanto hombres como mujeres mostraron un patrón anterior alto y posterior bajo. En el plano coronal, tanto hombres como mujeres mostraron la altura más alta en la posición media (P0,001). La TC puede medir los datos anatómicos del hiato espinal lumbosacro con mayor precisión. El dispositivo de fusión anterior integrado impreso en 3D de la columna lumbosacra diseñado de acuerdo con el análisis de los resultados de los datos está más en línea con la estructura anatómica de la columna lumbosacra, se adapta bien a las placas terminales superior e inferior y restaura eficazmente la altura y la parte anterior del ángulo de convexidad del espacio lumbosacro.

Access to the Lumbosacral Spine: A Current View.

The surgical approach to the lumbosacral spine has been the subject of experimental and scientific anatomical studies since the Hippocratic era. However, it was in the 20th century that, with the evolution of asepsis and antibiotic therapy, spine surgery began to evolve at breakneck speed, and the various possibilities of access roads became objects of development and discussion. As a result, pathologies of the lumbosacral spine can be accessed in different ways and positions, from the traditional posterior approach in the prone position to the anterior, oblique, lateral, and endoscopic approaches. The current article brings state-of-the-art access routes to the lumbosacral spine. This article objective is to elucidate the possibilities of accesses the lumbar spine for any purposes, as decompression, fusion, tumour resections, reconstruction or deformity correction, despites type of implants or implants positioning.

The Role of Trabecular, Ligamentous-Intervertebral Disk and Facet Joints Systems: A Finite Element Analysis in the L4-S1 Vertebrae.

STUDY DESIGN: Descriptive. OBJECTIVES: Trabecular bone in the vertebrae is critical for the distribution of load and stress throughout the neuroaxis, as well as the intervertebral disk, ligamentous complex, and facet joints. The objective was to assess the stress and strain distribution of the L4-S1 spine segment by a finite element analysis. METHODS: A lumbosacral spine model was built based on a CT-Scan. Trabecular-to-cortical bone distribution, ligaments, intervertebral disk, and facet joints with cartilage were included. A perpendicular force was applied over the L4 upper terminal plate of 300 N, 460 N and 600 N in neutral, plus 5 Nm and 7.5 Nm for flexion and extension movements. Maximum principal stress and total deformation were the main studied variables. RESULTS: Trabecular bone confers resistance to axial loads on the vertebrae by elastic capacity and stress distribution. MPS and TD showed axial stress attenuation in the nucleus pulposus and longitudinal ligaments, as well as load distribution capacity. Facet joints and discontinuous ligaments showed greater TD values in flexion moments but greater MPS values in extension, conferring stability to the lumbosacral junction and axial load distribution. CONCLUSION: We propose 3 anatomical systems for axial load distribution and stress attenuation in the lumbosacral junction. Trabecular bone distributes loads, while the ligamentous-intervertebral disk transmits and attenuate axial stress. Facet joints and discontinuous ligaments act as stabilizers for flexion and extension postures. Overall, the relationship between trabecular bone, ligamentous-intervertebral disk complex and facet joints is necessary for an efficient load distribution and segmental axial stress reduction.This slide can be retrieved from the Global Spine Congress 2023.

Evaluation of the technique of localization of the epidural space with the aid of a peripheral nerve stimulator and epidurographic, comparing two techniques for determining the infused volume, in rabbits (Oryctolagus Cuniculus).

Veterinary care for rabbits has been growing, and, consequently, the anesthetic and analgesic management of this species must be improved. The aim of the present study was to evaluate the technique of localization of the epidural space with the aid of a peripheral nerve stimulator and epidurographic, comparing two techniques for determining the infused volume in rabbits (Oryctolagus Cuniculus). In a prospective, randomized blinded study, six healthy New Zealand rabbits, adults, and weighing from 2.2 kg to 3.8 kg received two treatments, at 1 week intervals: 0.33 mL/kg (treatment I) or 0.05 mL per centimeter of the spine (treatment II) of ioexol epidurally. In both treatments, a peripheral nerve stimulator (2 Hz, 0.25 mA and 0.1 milliseconds) was used to determine the location of the epidural space. Latero-lateral and ventro-dorsal radiographs were taken after five (T5) and twenty-five minutes (T25) of iohexol administration. The epidural space was correctly accessed in 92% of attempts. Treatment I received a smaller volume of contrast than treatment II, 1.0 ± 0.2 mL versus 2.1 ± 0.1 mL (mean ± standard deviation), respectively (p = 0.007). At T5, the cranial progression of the contrast varied between L4 and L5 in treatment I, and L5 and T10 in treatment II. At T25, no contrast was observed in any rabbit. In conclusion, peripheral nerve stimulator aided in accessing the lumbosacral epidural space, and the administration of 0.05 mL per centimeter of the spine resulted in greater cranial progression of contrast.

Access to the Lumbosacral Spine: A Current View / Acesso à coluna lombossacral: Visão atual

Abstract The surgical approach to the lumbosacral spine has been the subject of experimental and scientific anatomical studies since the Hippocratic era. However, it was in the 20th century that, with the evolution of asepsis and antibiotic therapy, spine surgery began to evolve at breakneck speed, and the various possibilities of access roads became objects of development and discussion. As a result, pathologies of the lumbosacral spine can be accessed in different ways and positions, from the traditional posterior approach in the prone position to the anterior, oblique, lateral, and endoscopic approaches. The current article brings state-of-the-art access routes to the lumbosacral spine. This article objective is to elucidate the possibilities of accesses the lumbar spine for any purposes, as decompression, fusion, tumour resections, reconstruction or deformity correction, despites type of implants or implants positioning.

Resumo A abordagem cirúrgica da coluna lombossacral tem sido objeto de estudos anatômicos experimentais e científicos desde a era hipocrática. Contudo, foi no século XX que, com a evolução da assepsia e da antibioticoterapia, a cirurgia da coluna começou a evoluir em velocidade vertiginosa e as diversas possibilidades de vias de acesso tornaram-se objetos de desenvolvimento e discussão. Desta forma, as doenças da coluna lombossacral podem ser acessadas de diferentes maneiras e posições, desde a abordagem posterior tradicional em decúbito ventral até as abordagens anterior, oblíqua, lateral e endoscópica. O presente artigo traz vias de acesso de última geração para a coluna lombossacral. O objetivo deste artigo é elucidar as possibilidades de acesso à coluna lombar para quaisquer finalidades, como descompressão, fusão, ressecções tumorais, reconstrução ou correção de deformidades, independentemente do tipo de implante ou seu posicionamento.

Caracterización de un grupo de pacientes sometidos a herniorrafia lateral con malla retromuscular en un centro de tercer nivel de 2015 a 2019 / Characterization of a group of patients who underwent lateral herniorrhaphy with retromuscular mesh in a third level center from 2015 to 2019

Introducción. El objetivo de este estudio fue describir las características de la población y determinar las principales complicaciones de los pacientes que son llevados a cirugía por hernia lateral en el abdomen. Métodos. Estudio observacional retrospectivo, que incluyó a los pacientes sometidos a herniorrafia lateral, entre 2015 y 2019 en un centro de tercer nivel. La información se obtuvo del registro de historias clínicas. Las variables analizadas se clasificaron según las características sociodemográficas de los pacientes, clínicas y quirúrgicas. Se hizo una caracterización de acuerdo con los resultados encontrados. Resultados. Se incluyeron 51 pacientes con hernia lateral, 29 de ellos mujeres, con un promedio de edad de 59 años y de índice de masa corporal de 28 kg/m2. El 60 % tenía comorbilidades de base, siendo la hipertensión arterial la más frecuente. La mayoría se clasificaron como ASA II. En cuanto a la localización, la L3 fue la más común (37,2 %). Se presentaron complicaciones postquirúrgicas en el 27,4 % de los pacientes, siendo las más frecuentes seromas, hematomas e infecciones de sitio operatorio. Ningún paciente requirió reintervención para el manejo de las complicaciones. Conclusión. Conocer la población y determinar cuáles son las principales complicaciones postquirúrgicas de un procedimiento permite tomar medidas para disminuir su frecuencia, pero en este caso, se necesitan estudios adicionales para determinar cuáles son los mayores factores asociados a las complicaciones

Introduction. To describe the characteristics of the population and to determine the main complications of patients who undergo surgery for lateral hernia. Methods. We performed a retrospective observational study, including patients who underwent lateral herniorrhaphy between 2015 and 2019 in a third-level medical center, obtaining information through the registration of medical records. The analyzed variables were classified according to the patients' clinical, surgical and sociodemographic characteristics, performing a characterization according to the results found. Results. Fifty-one patients due to lateral hernia were included, 29 of them were women, with a mean age of 59 years and a body mass index of 28 Kg/m2. Of those, 60% presented basic comorbidities, being arterial hypertension the most frequent. Most were classified as ASA II. Regarding the location, the L3 was the most commonly presented hernia, referring to 37.2%. Postoperative complications occurred in 27.4% of the patients, with seromas being the most frequent, followed by hematomas and surgical site infections. No patient required reintervention for the management of complications. Conclusion. By knowing the population and determining which are the main complications, measures can be taken to reduce their incidence. Additional studies are needed to determine which are the main factors associated with complications

Lumbar vertebral pattern variation in the common opossum (Didelphis marsupialis Linnaeus, 1758): implication on lumbar nerve distribution.

The lumbar nerve distribution can differ depending on vertebral count variations among individuals of the same species. The variation in the lumbar vertebra formula and the lumbar nerve distribution in twenty adult common opossums (eight female and twelve males) was studied. Radiographs were taken to confirm vertebral identification and count. Two vertebral patterns were recognized: three specimens presented five lumbar vertebrae (5VP) and seventeen individuals presented six lumbar vertebrae (6VP). All the 6VP specimens had the same innervation pattern; however, the 5PV had three different innervation patterns (5PVa, 5VPB, and 5PVc). 5VPa and 6VP differed only in the origin of the lateral femoral cutaneous nerve (L2-L3 and L3, respectively). The differences among 5PVa, 5PVb, and 5VPc were seen in the iliohypogastric nerve, which was formed by L1 in 5VPa and 5VPb, and T13 in 5VPc. The ilioinguinal nerve was formed by L1-L2 in 5VPa and 5VPb, while it was formed by T13-L1 in 5VPc. The genitofemoral nerve was formed by L2-L3 in 5VPa, L2 in 5VPb, and L1-L2 in 5VPc. The cutaneous femoris lateralis was formed by L2-L3 in 5VPa and 5VPc, while it is formed only by L2 in 5VPb. The femoral and obturator nerves were formed by L3-L4 in 5VPa, and L2-L3 in 5VPb and 5VPc. The lumbosacral trunk originated from L4-L5-S1 in 5VP and L5-L6-S1 in 6VP. The data provided in this study may help understand the relationship between the spine and lumbosacral plexus variations and may find application in veterinary spine surgery.

The Brazilian Portuguese version of the Pregnancy Mobility Index: Cross-cultural adaptation and psychometric evaluation - a validation study

ABSTRACT BACKGROUND: The Pregnancy Mobility Index (PMI) was developed to assess mobility in pregnant women in the Netherlands. At present, no similar questionnaire is available in Brazil. OBJECTIVE: The present study aimed to translate, cross-culturally adapt, and evaluate the psychometric properties of a Brazilian PMI. DESIGN AND SETTING: The present study was a validation study conducted at the Universidade Federal do Paraná and a public maternity ward in Curitiba, Brazil. METHODS: Text translation and cross-cultural adaptation followed international guidelines. Construct validity, internal consistency, and inter- and intra-rater reliability tests included 97 women. The Pelvic Girdle Questionnaire, Multidimensional Pain Evaluation Scale, Schober's test, and lumbar spine range of motion assessment were administered on the first day. Intra-rater reliability (n = 19) was measured after 15 days. Exploratory factor analysis was performed, and the correlation matrix was analyzed using Pearson's coefficient. RESULTS: Pregnant women (88%) understood the cultural adaptation process. The internal consistency was high (Cronbach's alpha > 0.90), construct validity was moderate, with significant correlation between lumbar spine range of motion (r = 0.283-0.369) and Schober's test (r = -0.314), and high correlation between the Multidimensional Pain Evaluation Scale (r = -0.650 and -0.499) and Pelvic Girdle Questionnaire (r = -0.737). Intra- and inter-rater reliabilities were excellent (intraclass correlation coefficient = 0.932 and 0.990, respectively). CONCLUSION: The Brazilian version of the PMI was successfully translated with excellent reliability and moderate-to-high construct validity. It is an important tool for assessing mobility in pregnant women. CLINICAL TRIAL: RBR-789tps (Validation study), https://ensaiosclinicos.gov.br/rg/RBR-789tps.

Correlation Between Cage Positioning and Lumbar Lordosis in Transforaminal Lumbar Interbody Fusion (TLIF).

Objective The present study evaluates radiographic outcomes and the lumbar lordosis achieved with a transforaminal lumbar interbody fusion (TLIF) arthrodesis technique according to the positioning of an interbody device (cage) in the disc space. Methods This is a retrospective radiographic analysis of single-level surgical patients with degenerative lumbar disease submitted to a TLIF procedure and posterior pedicle instrumentation. We divided patients into two groups according to cage positioning. For the TLIF-A group, the cages were anterior to the disc space; for the TLIF-P group, cages were posterior to the disc space. Considering the superior vertebral plateau of the lower vertebra included in the instrumentation, cages occupying a surface equal to the anterior 50% of the midline were placed in the TLIF-A group, and those in a posterior position were placed in the TLIF-P group. We assessed pre- and postoperative orthostatic lateral radiographs to obtain the following measures: lumbar lordosis (LL) (angle L1-S1), segmental lordosis (LS) (L4-S1), and segmental lordosis of the cage (SLC). Results The present study included 100 patients from 2011 to 2018; 44 were males, and 46 were females. Their mean age was 50.5 years old (range, 27 to 76 years old). In total, 43 cages were "anterior" (TLIF-A) and 57 were "posterior" (TLIF-P). After surgery, the mean findings for the TLIF-A group were the following: LL, 50.7°, SL 34.9°, and SLC 21.6°; in comparison, the findings for the TLIF-P group were the following: LL, 42.3° ( p < 0.01), SL 30.7° ( p < 0.05), and SLC 18.8° ( p > 0.05). Conclusion Cage positioning anterior to the disc space improved lumbar and segmental lordosis on radiographs compared with a posterior placement.

Correlation Between Cage Positioning and Lumbar Lordosis in Transforaminal Lumbar Interbody Fusion (TLIF) / Correlação entre posicionamento do cage e lordose lombar em fusão transforaminal minimamente invasiva (TLIF)

Abstract Objective The present study evaluates radiographic outcomes and the lumbar lordosis achieved with a transforaminal lumbar interbody fusion (TLIF) arthrodesis technique according to the positioning of an interbody device (cage) in the disc space. Methods This is a retrospective radiographic analysis of single-level surgical patients with degenerative lumbar disease submitted to a TLIF procedure and posterior pedicle instrumentation. We divided patients into two groups according to cage positioning. For the TLIF-A group, the cages were anterior to the disc space; for the TLIF-P group, cages were posterior to the disc space. Considering the superior vertebral plateau of the lower vertebra included in the instrumentation, cages occupying a surface equal to the anterior 50% of the midline were placed in the TLIF-A group, and those in a posterior position were placed in the TLIF-P group. We assessed pre- and postoperative orthostatic lateral radiographs to obtain the following measures: lumbar lordosis (LL) (angle L1-S1), segmental lordosis (LS) (L4-S1), and segmental lordosis of the cage (SLC). Results The present study included 100 patients from 2011 to 2018; 44 were males, and 46 were females. Their mean age was 50.5 years old (range, 27 to 76 years old). In total, 43 cages were "anterior" (TLIF-A) and 57 were "posterior" (TLIF-P). After surgery, the mean findings for the TLIF-A group were the following: LL, 50.7°, SL 34.9°, and SLC 21.6°; in comparison, the findings for the TLIF-P group were the following: LL, 42.3° (p< 0.01), SL 30.7° (p< 0.05), and SLC 18.8° (p> 0.05). Conclusion Cage positioning anterior to the disc space improved lumbar and segmental lordosis on radiographs compared with a posterior placement.

Resumo Objetivo Avaliar os resultados radiográficos e comparar a lordose pós-operatória em técnica de artrodese intersomática lombar transforaminal (TLIF, na sigla em inglês), considerando como variável o posicionamento do dispositivo intersomático (cage) em relação ao espaço discal. Métodos Análise retrospectiva radiográfica de pacientes cirúrgicos, em nível único, por doença lombar degenerativa, aplicando-se TLIF e instrumentação pedicular posterior. Os pacientes foram divididos, conforme a posição do cage, em 2 grupos: 1. TLIF-A - cages na posição anterior do espaço discal; e 2. TLIF-P, cages na posição posterior do espaço discal (considerando-se o platô vertebral superior da vértebra inferior incluída na instrumentação, cages que ocuparam a superfície correspondente a 50% anterior da linha média, compuseram o grupo TLIF-A; opostamente, cages em posicionamento posterior compuseram o grupo TLIF-P). Procedeu-se à avaliação dos exames radiográficos ortostáticos em perfil no pré- e pós-operatórios, com a tomada das seguintes medidas: lordose lombar (LL) (ângulo L1-S1); lordose segmentar (LS) (L4-S1) e lordose segmentar do cage (LSC). Resultados Cem pacientes foram incluídos de 2011 a 2018, sendo 44 homens e 46 mulheres, com idade média de 50.5 anos (27-76 anos). Um total de 43 cages foram classificados como "anteriores" (TLIF-A) e 57, "posteriores" (TLIF-P); considerando o grupo TLIF- A, os resultados pós-operatórios médios foram: LL 50.7°, LS 34.9° e LSC 21.6°; para o grupo TLIF-P, comparativamente: LL 42.3° (p< 0,01), LS 30.7° (p< 0,05) e LSC 18.8° (p> 0,05). Conclusão O posicionamento anterior do cage em relação ao espaço discal correlaciona-se a melhora da lordose lombar e segmentar na radiografia em comparação com o posicionamento posterior do implante.

Cerebrospinal fluid leak following penetrating trauma to the spine without neurological deficit: A case report.

Background: Posttraumatic spinal cerebrospinal fluid leak (CSFL) without neurological deficit is a rare entity. Historically, the first-line treatment is a nonsurgical approach, which includes Trendelenburg positioning, carbonic anhydrase inhibitor (acetazolamide), and subarachnoid catheter, with a high successful rate of leak correction. However, in some cases, this first-line treatment could fail, being necessary the surgical approach. Case Description: A 23-year-old male with a recent stab wound to his lumbar region, complained of positional headache and fluid outflow through his wound. On physical examination, an active CSFL was detected without evidence of neurologic deficit. Imaging studies showed a CSF collection extending from the right L4 lamina to the subcutaneous tissue. CSF studies revealed bacterial meningitis. The treatment with carbonic anhydrase inhibitors, Trendelenburg position, lumbar subarachnoid catheter, and antibiotics was initiated. Failure of conservative measures prompted a surgical treatment to resolve the CSFL. Intraoperatively, a dura mater defect was identified, and an autologous paravertebral muscle flap was used for water-tight closure of the defect. The patient recovered without further complications and with CSFL resolution. Conclusion: Even though the nonsurgical approach is the first-line of treatment of traumatic CSFL cases, failures can occur. The evidence of a CSF trajectory in imaging studies could be a predictor of treatment failure of the nonsurgical treatment. The surgical treatment as second-line treatment has outstanding results regarding CSFL correction and should be considered when the prediction rate to nonsurgical approach failure is high.

Improvement in Radicular Pain after Endoscopic Transforaminal Lumbar Discectomy at Discs with Advanced Degenerative Changes.

Objectives To evaluate the correlation between radiologic changes (Pfirrmann and Modic) and radicular pain intensity in patients who underwent transforaminal endoscopic surgery for lumbar disc herniation. Methods Series of cases with 39 patients, 50 intervertebral discs in preoperative evaluation from January 29, 2018 to August 28, 2019 in an endoscopic spine surgery service. Demographic data, surgical indication, operative details and complications were obtained from medical records. The patients were divided into three groups based on the Modic classification (Modic absence, Modic 1 and Modic 2) and into two groups considering the Pfirrmann classification (Pfirrmann IV and Pfirrmann V). Data were processed in IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp., Armonk, NY, USA), with a significance level of p < 0,05. Results There was no difference between genders; age: 50,36 ± 15,05 years old; disease level: L2-L3 1 (2%), L3-L4 2 (4%), L4-L5 9 (18%), L5-S1 8 (16%), L3-L4 + L4-L5 4 (8%), and L4-L5 + L5-S1 26 (52%); location: right foraminal 7 (14%), left foraminal 15 (30%), central 9 (18%) and diffuse 19 (38%); radicular pain: left 25 (50%), right 11 (22%), and bilateral 14 (28%); preoperative visual analogue scale (VAS): 9,5 ± 0,91, postoperative: 2,5 ± 1,79; surgery duration: 100 ± 31,36 minutes; and follow-up: 8,4 ± 6,7 months. Less postoperative sciatica was registered in the Modic 2 versus Modic 1 group ( p < 0,05). There was no difference in the postoperative radicular pain between the Pfirrmann groups (IV versus V). Conclusion Although there is no clinical difference between the groups, in advanced stages of disc degeneration, endoscopic transforaminal discectomy proved to be effective in diminishing radicular pain in patients with lumbar disc herniation.

Improvement in Radicular Pain after Endoscopic Transforaminal Lumbar Discectomy at Discs with Advanced Degenerative Changes / Melhora da dor radicular após discectomia lombar transforaminal endoscópica em discos com alterações degenerativas avançadas

Abstract Objectives To evaluate the correlation between radiologic changes (Pfirrmann and Modic) and radicular pain intensity in patients who underwent transforaminal endoscopic surgery for lumbar disc herniation. Methods Series of cases with 39 patients, 50 intervertebral discs in preoperative evaluation from January 29, 2018 to August 28, 2019 in an endoscopic spine surgery service. Demographic data, surgical indication, operative details and complications were obtained from medical records. The patients were divided into three groups based on the Modic classification (Modic absence, Modic 1 and Modic 2) and into two groups considering the Pfirrmann classification (Pfirrmann IV and Pfirrmann V). Data were processed in IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp., Armonk, NY, USA), with a significance level of p< 0,05. Results There was no difference between genders; age: 50,36 ± 15,05 years old; disease level: L2-L3 1 (2%), L3-L4 2 (4%), L4-L5 9 (18%), L5-S1 8 (16%), L3-L4 + L4-L5 4 (8%), and L4-L5 + L5-S1 26 (52%); location: right foraminal 7 (14%), left foraminal 15 (30%), central 9 (18%) and diffuse 19 (38%); radicular pain: left 25 (50%), right 11 (22%), and bilateral 14 (28%); preoperative visual analogue scale (VAS): 9,5 ± 0,91, postoperative: 2,5 ± 1,79; surgery duration: 100 ± 31,36 minutes; and follow-up: 8,4 ± 6,7 months. Less postoperative sciatica was registered in the Modic 2 versus Modic 1 group (p< 0,05). There was no difference in the postoperative radicular pain between the Pfirrmann groups (IV versus V). Conclusion Although there is no clinical difference between the groups, in advanced stages of disc degeneration, endoscopic transforaminal discectomy proved to be effective in diminishing radicular pain in patients with lumbar disc herniation.

Resumo Objetivos Avaliar a correlação entre as alterações radiológicas (Pfirrmann e Modic) e a intensidade da dor radicular em pacientes submetidos a cirurgia endoscópica transforaminal para hérnia de disco lombar. Métodos Uma sequência de casos com 39 pacientes, 50 discos intervertebrais em avaliação pré-operatória, no período de 29 de janeiro de 2018 a 28 de agosto de 2019, no serviço de cirurgia endoscópica da coluna vertebral. Os dados demográficos, indicação cirúrgica, detalhes operatórios e complicações foram todos obtidos junto aos prontuários clínicos. Os pacientes foram divididos em três grupos, com base na classificação Modic (ausência de Modic, Modic 1 e Modic 2) e em dois grupos, considerando a classificação de Pfirrmann (Pfirrmann IV e Pfirrmann V). Os dados foram processados no software IBM SPSS Statistics for Windows, versão 22.0 (IBM Corp., Armonk, NY, EUA), com nível de significância de p <0,05. Resultados Não houve diferença entre os gêneros; idade: 50,36 ± 15,05 anos; nível da doença: L2-L3 1 (2%), L3-L4 2 (4%), L4-L5 9 (18%), L5-S1 8 (16%), L3-L4 + L4-L5 4 (8%), e L4-L5 + L5-S1 26 (52%); localização: foraminal direito em 7 pacientes (14%), foraminal esquerdo em 15 pacientes (30%), central em 9 pacientes (18%), e difuso em 19 pacientes (38%); dor radicular: esquerda em 25 pacientes (50%), direita em 11 pacientes (22%), e bilateral em 14 pacientes (28%); escala visual analógica (EVA) pré-operatório: 9,5 ± 0,91, pós-operatório: 2,5 ± 1,79; tempo cirúrgico: 100 ± 31,36 minutos; e acompanhamento de 8,4 ± 6,7 meses. Foi registrada menos dor ciática pós-operatória nos grupos Modic 2 versus Modic 1 (p< 0,05). Não houve diferença na dor radicular pós-operatória entre os grupos Pfirrmann (IV versus V). Conclusão Embora não exista diferença clínica entre os grupos, em estágios avançados da degeneração discal, a discectomia transforaminal endoscópica mostrou-se eficaz na redução da dor radicular em pacientes com hérnia de disco lombar.

Current results of conventional lumbar arthrodesis / Resultados atuais da artrodese lombar convencional / Resultados actuales de la artrodesis lumbar convencional

ABSTRACT Objective: To evaluate the peri- and postoperative results and clinical repercussions in patients undergoing decompression surgery and single-level lumbar arthrodesis using the traditional technique (OTLIF) and to compare with the results of minimally invasive techniques (MITLIF) described in the literature. Methods: Our sample consisted of 22 patients who underwent TLIF surgery using the open technique (OTLIF) in the period October 2019 to January 2021, in our hospital. We compared the patients' functional clinical results using the Oswestry scale in the preoperative period and 15 days after surgery, analyzed variables related to the perioperative period: surgery time, length of hospital stay, blood loss, use of a suction drain, and admission to the ICU, and compared these with the results reported in the literature for patients treated by the MITLIF technique. Results: The average age was 48.95 years and the most operated level was L4-L5 (55%). The average surgery time was 112.63 min. We did not use a suction drain in the postoperative period, there was no need for a blood transfusion in any patient, and no patient was admitted to the ICU. The average hospital stay was 1 day. Regarding the Oswestry Disability Index, the mean preoperative score was 44.73 and after 15 days, it was 24.05. Conclusions: surgical treatment using the OTLIF technique for single-level lumbar degenerative disease showed largely positive results, with improvement in disability scores, short hospital stay and low incidence of complications. When properly indicated, OTLIF is an excellent and safe option for the treatment of degenerative lumbar disease. Level of evidence IV; Case series study.

RESUMO Objetivo: Avaliar resultados e repercussões clínicas precoces no peri e pós-operatório de pacientes submetidos à cirurgia de descompressão e artrodese lombar de um nível pela técnica tradicional (OTLIF) e comparar com resultados das técnicas minimamente invasivas (MITLIF) descritos na literatura. Métodos: Nossa amostra foi composta por 22 pacientes submetidos à cirurgia de TLIF pela técnica aberta (OTLIF) no período de outubro/2019 a janeiro/2021 em nosso hospital. Comparamos os resultados clínicos funcionais dos pacientes pela escala de Oswestry no pré-operatório e 15 dias de depois da cirurgia e analisamos variáveis relacionadas com o período perioperatório, a saber, tempo de cirurgia, tempo de internação hospitalar, perda de sangue, uso de dreno e internação em UTI, e comparamos com os resultados da literatura em pacientes tratados pela técnica MITLIF. Resultados: A média de idade foi de 48,95 anos e o nível mais abordado foi L4-L5 (55%). O tempo operatório médio foi de 112,63 minutos. Não utilizamos dreno no pós-operatório, não houve necessidade de transfusão de sangue em nenhum paciente e nenhum deles foi internado em UTI. O tempo médio de internação hospitalar foi de um (1) dia. Com relação ao Índice de Incapacidade de Oswestry, a pontuação pré-operatória média foi de 44,73 e depois de 15 dias foi de 24,05. Conclusões: O tratamento cirúrgico pela técnica OTLIF na doença degenerativa lombar de um nível apresentou resultados amplamente positivos, com melhora nos escores de incapacidade, baixo tempo de internação e baixa incidência de complicações. Quando bem indicada, a OTLIF é uma opção excelente e segura para o tratamento da doença degenerativa lombar. Nível de evidência IV; Série de casos.

RESUMEN Objetivo: Evaluar resultados y repercusiones clínicas precoces perioperatorias y postoperatorias de pacientes sometidos a cirugía de descompresión y artrodesis de un nivel por técnica tradicional (OTLIF); y compararlos con resultados de las técnicas mínimamente invasivas (MITLIF) descritos en la literatura. Métodos: Nuestra muestra fue formada por 22 pacientes sometidos a cirugía TLIF por técnica abierta (OTLIF), en el período comprendido entre octubre/2019 y enero/2021 en nuestro hospital. Se compararon los resultados clínicos funcionales de los pacientes mediante escala de Oswestry en preoperatorio y después de 15 días de cirugía y, analizaron las variables relacionadas al perioperatorio como tiempo de cirugía, tiempo de internación, pérdida de sangre, uso de drenaje e internación en UCI y se compararon con resultados de la literatura de pacientes tratados por la técnica MITLIF. Resultados: La media de edad fue de 48,95 años y nivel más abordado fue L4-L5 (55%). El tiempo promedio de operación fue 112,63 minutos. No se utilizó drenaje en el postoperatorio, no hubo necesidad de transfusión de sangre en ningún paciente y ninguno de ellos fue ingresado en la UCI. El tiempo promedio de internación fue 1 día. Con respecto al Índice de Discapacidad de Oswestry, la puntuación preoperatoria media fue 44,73 y después de 15 días, 24,05. Conclusiones: El tratamiento quirúrgico por técnica OTLIF en la enfermedad degenerativa lumbar de un nivel presentó resultados ampliamente positivos, con mejora en los escores de discapacidad, bajo tiempo de internación y baja incidencia de complicaciones. Bien indicada, OTLIF es una excelente y segura opción para el tratamiento de la enfermedad degenerativa lumbar. Nivel de evidencia IV; Serie de casos.

[Lumbosacral arthrodesis in construction workers. Return to work]. / Artrodesis lumbosacra en trabajadores de la construcción. Reinserción laboral.

Degenerative spinal disease is the leading cause of low back pain and sciatica in the general population. It is an important cause of absenteeism and increased expenses. Its incidence increases in people subjected to tasks that overload the spine, such as construction workers. Instrumented arthrodesis is a frequent practice with satisfactory results for its resolution. To date, in our country, we haven't found statistical data on this group of work-related patients. Our objective was to evaluate laboral impact generated by instrumented lumbosacral arthrodesis in construction workers. We did a retrospective, descriptive, comparative and monocentric study. Construction workers' patients with degenerative low back pain and instrumented lumbar or lumbosacral arthrodesis who were operated between January 2005 to August 2018 were included. Clinical and imaging evaluation and follow-up for a period of 18 to 24 months. Assessed with the Oswestry Disability Index (IDO) and the Visual Analog Pain Scale (VAS). The sample was analyzed in groups according to the functions at the time of returning to work, retirement or dismissal. We evaluated 139 patients. Mean age 42 years, degenerative spinal disease of the lumbosacral segment, 66.9% of the sample without postoperative complications resumed the same pre-surgical activity. Post-surgical IDO and VAS scores were worse in patients discharged, retired, and/or requalified. Patients under 42 years of age, without postoperative complications who improved more than 1 Oswestry category, returned to their usual tasks with satisfactory results in the medium and long term.

La enfermedad degenerativa del raquis es la causa más frecuente de lumbalgia y ciática en la población general provocando ausentismo, lo que incrementa el gasto en salud de los distintos subsistemas, así como el gasto del empleador quien deberá suplantar al trabajador. Su incidencia aumenta en personas sometidas a tareas de sobrecarga del raquis, como el caso de obreros de la construcción. La artrodesis instrumentada es una práctica frecuente y con resultados satisfactorios para su resolución. No hemos encontrado publicaciones con datos estadísticos locales sobre este tema. El objetivo fue evaluar el impacto laboral que genera la artrodesis lumbosacra instrumentada en trabajadores de la construcción. Realizamos un estudio retrospectivo, descriptivo, comparativo y monocéntrico, entre enero de 2005 y agosto de 2018, de trabajadores de la construcción con artrodesis del segmento lumbosacro por lumbalgia de origen degenerativo con evaluación y seguimiento clínico e imagenológico por un periodo de 18 a 24 meses, utilizando el Índice de Discapacidad de Oswestry (IDO) y la Escala Visual Analógica del Dolor (EVA). Se analizó la muestra en grupos según las funciones al momento del retorno laboral, jubilación o despido. Se evaluaron 139 pacientes (mediana 42 años). El 66.9% de la muestra no tuvo complicaciones postoperatorias y retomó la misma actividad prequirúrgica. Los puntajes de IDO y EVA postquirúrgicos fueron peores en los pacientes despedidos, jubilados y/o recalificados. Los menores de 42 años, sin complicaciones postoperatorias que mejoran más de 1 categoría del Oswestry retomaron sus tareas habituales con resultados satisfactorios a mediano y largo plazo.

Artrodesis lumbosacra en trabajadores de la construcción. Reinserción laboral / Lumbosacral arthrodesis in construction workers. Return to work

Resumen La enfermedad degenerativa del raquis es la causa más frecuente de lumbalgia y ciática en la población general provocando ausentismo, lo que incrementa el gasto en salud de los distintos subsistemas, así como el gasto del empleador quien deberá suplantar al trabajador. Su incidencia aumenta en personas sometidas a tareas de sobrecarga del raquis, como el caso de obreros de la construcción. La artrodesis instrumentada es una práctica frecuente y con resultados satisfactorios para su resolución. No hemos encon trado publicaciones con datos estadísticos locales sobre este tema. El objetivo fue evaluar el impacto laboral que genera la artrodesis lumbosacra instrumentada en trabajadores de la construcción. Realizamos un estudio retrospectivo, descriptivo, comparativo y monocéntrico, entre enero de 2005 y agosto de 2018, de trabajadores de la construcción con artrodesis del segmento lumbosacro por lumbalgia de origen degenerativo con evaluación y seguimiento clínico e imagenológico por un periodo de 18 a 24 meses, utilizando el Índice de Discapacidad de Oswestry (IDO) y la Escala Visual Analógica del Dolor (EVA). Se analizó la muestra en grupos según las funciones al momento del retorno laboral, jubilación o despido. Se evaluaron 139 pacientes (mediana 42 años). El 66.9% de la muestra no tuvo complicaciones postoperatorias y retomó la misma actividad prequirúrgica. Los puntajes de IDO y EVA postquirúrgicos fueron peores en los pacientes despedidos, jubilados y/o recalificados. Los menores de 42 años, sin complicaciones postoperatorias que mejoran más de 1 categoría del Oswestry retomaron sus tareas habituales con resultados satisfactorios a mediano y largo plazo.

Abstract Degenerative spinal disease is the leading cause of low back pain and sciatica in the general population. It is an important cause of absenteeism and increased expenses. Its incidence increases in people subjected to tasks that overload the spine, such as construction workers. Instrumented arthrodesis is a frequent practice with satisfactory results for its resolution. To date, in our country, we haven´t found statistical data on this group of work-related patients. Our objective was to evaluate laboral impact generated by instrumented lumbosacral arthrodesis in construction workers. We did a retrospective, descriptive, comparative and monocentric study. Construction workers' patients with degenerative low back pain and instrumented lumbar or lumbosacral arthrodesis who were operated between January 2005 to August 2018 were included. Clinical and imaging evaluation and follow-up for a period of 18 to 24 months. Assessed with the Oswestry Disability Index (IDO) and the Visual Analog Pain Scale (VAS). The sample was analyzed in groups according to the functions at the time of returning to work, retirement or dismissal. We evaluated 139 patients. Mean age 42 years, degenerative spinal disease of the lumbosacral segment, 66.9% of the sample without postoperative complications resumed the same pre-surgical activity. Post-surgical IDO and VAS scores were worse in patients discharged, retired, and/or requalified. Patients under 42 years of age, without postoperative complications who improved more than 1 Oswestry category, returned to their usual tasks with satisfactory results in the medium and long term.

Terapia manual e exercícios de ampliação de canais versus fisioterapia convencional em estenose lombar - um protocolo de estudo / Manual therapy and canal enlargement exercises versus conventional physiotherapy in lumbar stenosis ­ a study protocol

INTRODUÇÃO: A estenose do canal lombar (ECL) é conhecida como a razão bem estabelecida de dor e capacidade de marcha reduzida em pacientes com manifestações de parestesia e dor na parte inferior das costas, região glútea, coxa posterior e pernas, denominadas 'Claudicação Neurogênica' (NC). A terapia manual combinada com exercícios de alargamento do canal e fisioterapia convencional pode ser considerada na erradicação dos sintomas de dor e NC, melhorando assim a qualidade de vida. MÉTODOS E MATERIAIS: Pacientes com LCS com canal de diâmetro de 8-12 mm no nível de L 4 e abaixo serão recrutados para este estudo por meio do método de randomização em Bloco. Eles serão randomizados em dois grupos de intervenção: grupos Terapia Manual e Alargamento dos Canais (MTCE) (n = 16) e Fisioterapia Convencional (Cp) (n = 16). O grupo MTCE receberá terapia manual e exercícios de alargamento do canal, enquanto o grupo Cp receberá apenas fisioterapia convencional. Ambos os grupos de intervenção receberão 3 dias de tratamento por semana durante 4 semanas. O questionário de deficiência de Oswestry modificado (MODI), diâmetro do canal ântero-posterior (AP), escala numérica de dor (NPRS) e distância de claudicação (CD) serão usados para a avaliação. O índice de deficiência de Oswestry modificado, diâmetro do canal AP, NPRS, distância de claudicação e SLR serão medidos no início e após a intervenção. DISCUSSÃO: Os resultados desta pesquisa ditarão a aplicabilidade da terapia manual com um protocolo de exercícios de alargamento do canal na dor e incapacidade funcional em pacientes com SCL.

INTRODUCTION: Lumbar Canal Stenosis (LCS) is known as the well-established reason for pain and depleted walking capacity in patients with manifestations of paresthesia and pain in the lower back, gluteal region, posterior thigh, and legs which are termed as 'Neurogenic Claudication' (NC). Manual therapy combined with canal enlargement exercises and conventional physiotherapy may be considered in eradicating pain and NC symptoms, hence improving the quality of life. METHODS AND MATERIALS: Patients with LCS with canal diameter 8-12 mm at the level of L4 and below will be recruited for this study. Through the Block randomization method, they will be randomized into two interventional groups: Manual Therapy & Canal Enlargement (MTCE) (n=16) and Conventional Physiotherapy (Cp) (n=16) groups. MTCE group will receive manual therapy and canal enlargement exercises, while the Cp group will receive only conventional physiotherapy. Both interventional groups will receive 3 days of treatment per week for 4 weeks. Modified Oswestry Disability questionnaire (MODI), AnteroPosterior (AP) canal diameter, Numeric Pain Rating Scale (NPRS), and Claudication Distance (CD) will be used for the evaluation. In addition, modified Oswestry Disability Index, AP canal Diameter, NPRS, Claudication distance, an SLR will be measured at baseline and post-intervention. DISCUSSION: The results of this research will dictate the applicability of manual therapy with an exercise protocol of canal enlargement exercises on pain and functional disability in patients with LCS.

Association between spinal alignment and biochemical composition of lumbar intervertebral discs assessed by quantitative magnetic resonance imaging.

BACKGROUND: To evaluate potential associations between spinopelvic parameters and the biochemical composition of lumbar intervertebral discs using quantitative magnetic resonance imaging in asymptomatic young adults. METHODS: Our study group comprised 93 asymptomatic volunteers aged 20-40 years (49 women and 44 men). Lumbar spine T2-weighted images and T2 relaxometry were acquired on a 1.5T MRI scanner. Spinopelvic parameters including sacral slope, pelvic tilt, pelvic incidence, lumbar lordosis, thoracic kyphosis, thoracolumbar alignment, sagittal vertical axis, spinosacral angle, C2 pelvic angle, and T1S1 and L1S1 length were measured on panoramic spine radiographs. RESULTS: Lumbar lordosis decrease correlates with discrete dehydration of nucleus pulposus at all lumbar levels. Also low values of sacral slope, pelvic tilt, pelvic incidence, thoracic kyphosis and spinosacral angle were associated with decrease of T2 relaxation times on annulus fibrosus. CONCLUSIONS: In conclusion, spinopelvic parameters presented a discrete association with lumbar disc composition and water content.

Prevalencia de enfermedad osteomioarticular lumbosacras y miembros inferiores en auxiliares de enfermería / Prevalence of lumbosacral and lower limb osteomyoarticular pathologies in nursing assistants / Prevalência de doença osteomioarticular lombossacral e de membros inferiores em auxiliares de enfermagem

RESUMEN Introducción: Los trabajadores de la salud se enfrentan permanentemente a labores complejas que afectan la región lumbar y miembros inferiores. Objetivo: Identificar la prevalencia de enfermedad osteomioarticular lumbosacras y miembros inferiores en auxiliares de enfermería Método: Se realizó un estudio epidemiológico, descriptivo y transversal en una muestra de 46 auxiliares del Distrito 18D04 de salud de Tungurahua, Ecuador. El instrumento aplicado fue un cuestionario para indagar variables sociodemográficas, antigüedad en el sector, horarios, tipos y tiempo de exposición a las labores habituales. Se utilizó la prueba estadística Chi-cuadrado, la paramétrica de correlación de Pearson y la prueba t de Student. Resultados: El 85 % de los estudiados presentó enfermedades lumbosacras y miembros inferiores durante el tiempo de trabajo, se apreció que el 39 % ha tenido una baja temporal al trabajo entre 1-3 días. Se identificó que la carga de peso es realizada por un 37 % y caminatas prolongadas en un 33 %. El 67 % tenía entre 11 y 40 años de trabajo y el resto menos de 10 años en el sector. El 54 % padeció enfermedades pertenecientes a miembros inferiores y un 46 % a lumbosacras. Conclusiones: El padecimiento de enfermedad osteomioarticular lumbosacras y miembros inferiores está relacionado con la edad y con padecerlas en los últimos doce meses, estas han provocado ausentismo laboral. No se comprobó una relación estadísticamente significativa con el padecimiento de enfermedad osteomioarticular con la antigüedad en el sector, las jornadas de trabajo y las actividades que más desarrollan.

ABSTRACT Introduction: Health care workers are constantly confronted with complex tasks that affect the lumbar region and lower limbs. Objective: To identify the prevalence of lumbosacral and lower limb osteomyoarticular pathologies in nursing assistants. Method: An epidemiological, descriptive and cross-sectional study was carried out in the 18D04 health district of Tungurahua, Ecuador. A total of 46 nursing assistants were selected in this study. We aimed a questionnaire to assess the sociodemographic variables, seniority in the health sector, time schedules, modes and time of exposure to the usual work. Chi-square test, Pearson's parametric correlation test, and the Student's t-test were used. Results: Most nursing assistants, the 85%, were diagnosed with lumbosacral and lower limb pathologies, and 39% took a temporary absence from work between 1-3 days. It was found that 37 % performed the heavy load work and 33% performed prolonged walks. The 67% had between 11 and 40 years of work and the rest had less than 10 years in the health sector. Fifty-four percent suffered from lower limb pathologies and 46% from lumbosacral pathologies. Conclusions: Lumbosacral and lower limb osteomyoarticular pathology is related to age, and their suffering in the last 12 months has led to a level of absenteeism in the workplace. There was no an important relationship, statistically, between osteomyoarticular pathology and seniority in the sector, working hours and the activities most frequently performed.

RESUMO Introdução: Os trabalhadores da saúde enfrentam constantemente tarefas complexas que afetam a região lombar e membros inferiores. Objetivo: Identificar a prevalência de doenças osteomioarticulares lombossacrais e de membros inferiores em auxiliares de enfermagem. Método: Estudo epidemiológico, descritivo e transversal em uma amostra de 46 auxiliares do Distrito Sanitário 18D04 de Tungurahua, Equador. O instrumento aplicado foi um questionário para investigar variáveis sociodemográficas, antiguidade no setor, horário, tipos e tempo de exposição a tarefas normais. Foram utilizados o teste estatístico Qui-quadrado, correlação paramétrica de Pearson e teste t de Student. Resultados: 85% dos estudados apresentaram doenças lombossacrais e de membros inferiores durante o tempo de trabalho, observou-se que 39% tiveram afastamento temporário do trabalho entre 1-3 dias. Identificou-se que a descarga de peso é realizada por 37% e as caminhadas prolongadas por 33%. 67% tinham entre 11 e 40 anos de trabalho e o restante menos de 10 anos no setor. 54% sofreram doenças pertencentes aos membros inferiores e 46% lombossacral. Conclusões: O sofrimento da doença osteomioarticular lombossacral e de membros inferiores está relacionado à idade e com o sofrimento nos últimos doze meses, estes têm causado absenteísmo ao trabalho. Não foi verificada relação estatisticamente significativa entre o sofrimento de doença osteomioarticular e o tempo de permanência no setor, a jornada de trabalho e as atividades que mais desenvolvem.

Origin and distribution of the lumbosacral plexus anatomy in van cats / Origen y distribución de la anatomía del plexo lumbosacro en gatos van

SUMMARY: The innervation of the pelvic limbs of the Van cat is investigated in this research. The origins of the nerves, the innervated muscles and nerve diameters were shown in a table. Five cat cadavers were used in the study. The pudendal nerve originated from the S1-S2 spinal nerves. The femoral nerve consisted of the ventral branches of the 5th and 6th lumbar nerves in 4 cats The ischiatic nerve was composed of the 6th and 7th lumbar (L6-L7) and S1 spinal nerves in all cadavers. The ischiatic nerve was the thickest branch of sacral plexus (the average diameter on the right side was 3.31 ± 0.27 mm and the average diameter on the left side was 3.28 ± 0.29 mm). The lumbosacral plexus was formed by the ventral branches of the L4-S3 spinal nerves. N.genitofemoralis consisted of only the ventral branches of L4 in all cadavers. N. femoralis did not give rise to a branch to the m. iliopsoas. N.plantaris lateralis was found to give a branch to the 3th finger. The quadriceps femoris muscles did not take any branches from either the ischiadicus nerve or the pudendal nerve. The obturator nerve did not receive any branches from the L4 spinal nerves. There was no branch to the skin from the caudal gluteal nerve. The thinnest nerve was the pudendal nerve. Due to the scarcity of studies on the lumbosacral plexus of cats, it is thought that this study will complete a gap in the field of veterinary anatomy.

RESUMEN: En esta investigación se estudió la inervación de los miembros pélvicos del gato Van. Los orígenes de los nervios, los músculos inervados y los diámetros de los nervios son mostrados en una tabla. En el estudio se utilizaron cinco cadáveres de gatos. En cuatro gatosel nervio pudendo se originaba a partir de los nervios espinales S1-S2. El nervio femoral consistió en los ramos ventrales de los nervios lumbares quinto y sexto. El nervio isquiático estaba compuesto por los nervios espinales sexto y séptimo lumbar (L6-L7) y S1 en todos los cadáveres. El nervio isquiático era el ramo más grueso del plexo sacro (el diámetro medio del lado derecho medía de 3,31 ± 0,27 mm y el diámetro medio izquierdo 3,28 ± 0,29 mm). El plexo lumbosacro estaba formado por los ramos ventrales de los nervios espinales L4-S3. N. genitofemoralis constaba solo de las ramas ventrales de L4 en todos los cadáveres. N. femoralis no dio lugar a un ramo a la m. iliopsoas. Los músculos del cuádriceps femoral no tomaron ningún ramo ni del nervio isquiático ni del nervio pudendo. El nervio obturador no recibió ramos de los nervios espinales L4. No existían ramos a la piel desde el nervio glúteo caudal. El nervio más delgado fue el nervio pudendo. Debido a la escasez de estudios sobre el plexo lumbosacro de los gatos, este estudio completará un vacío en el campo de la anatomía veterinaria.