By Henry Vernon Crock A.O., M.D., M.S., F.R.C.S., F.R.A.C.S. (auth.)
"... i'd suggest this publication for an in-depth research of the lumbar backbone and its degenerative states ... super important for the resident early in trainings as she or he makes an attempt to correlate the advanced anatomy of the lumbosacral zone with linked pathological states ...” magazine of Neurosurgery
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Extra info for A Short Practice of Spinal Surgery
That some dynamic pathological process is active gains further support in observations made during vertebral interbody fusion operations for this condition. For example, the lumbar sympathetic trunk may be found matted to such an affected disc and the adjacent paravertebral lymph nodes seen to be enlarged. In addition, the vascularity of the vertebral bodies adjacent to such a disc appears to be increased and their bony densities somewhat reduced. The significance of these findings relates to observations made during experiments on auto-immunity in the intervertebral discs of rabbits, reported by Bobechko and Hirsch (1965).
The nerve root canal in such cases becomes, in effect, a useless concept, as the dural sac lies against the medial wall of the upper lumbar pedicle. The emerging lumbar spinal nerve passes at once into the intervertebral foramen at its upper boundary immediately below the pedicle. The shape of the dural sac changes from a rounded tubular outline, tapering progressively from the level of L3 downwards. Contrasting with the upper two lumbar spinal nerves, the lower lumbar nerves are longer and come off at more acute angles from the sides of the dural sac.
Iii) Magnetic Resonance Imaging This investigation is emerging as the most useful single test in establishing the diagnosis of isolated disc resorption and in studying its evolution. Loss of signal on the T2 weighted image of the peripheral portions of the nucleus pulposus appears to be one of the earliest changes associated with the decrease in height between vertebral end-plates (Fig. 26). These changes are associated with a uniform bulging of the posterior annular fibres into the spinal canal seen in the sagittal images.
A Short Practice of Spinal Surgery by Henry Vernon Crock A.O., M.D., M.S., F.R.C.S., F.R.A.C.S. (auth.)