Percutaneous Nephrolithotomy Versus Ureteroscopic Lithotomy for Large (>15 mm) Impacted Upper Ureteral Stones in Different Locations: Is the Upper Border of the Fourth Lumbar Vertebra a Good Indication for Choice of Management Method?

2013 ◽  
Vol 27 (9) ◽  
pp. 1120-1125 ◽  
Author(s):  
Hai Li ◽  
Wanli Na ◽  
Hongyan Li ◽  
Yang Jiang ◽  
Xinquan Gu ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Lumbar Vertebra ◽  
Ureteral Stones ◽  
Management Method ◽  
Fourth Lumbar Vertebra

scholarly journals Compartment Syndrome Related to Patient Positioning in the Surgical Treatment of Urolithiasis

2021 ◽  
Author(s):  
Inés Laso-García ◽  
Fernando Arias-Fúnez ◽  
Gemma Duque-Ruiz ◽  
David Díaz-Pérez ◽  
Alberto Artiles-Medina ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Compartment Syndrome ◽  
Percutaneous Nephrolithotomy ◽  
Rare Complication ◽  
Patient Positioning ◽  
Lower Limbs ◽  
Urinary Stones ◽  
Ureteral Stones ◽  
Lithotomy Position ◽  
American Society

The incidence of urolithiasis is progressively increasing worldwide, as is the surgical treatment of urinary stones. The most frequent surgery for urolithiasis is ureterorenoscopy, which is performed in the lithotomy position. This position is also used in the endoscopic approach to bladder stones. Lateral decubitus is rarely used in the treatment of urinary stones. In the case of complex kidney stones, the gold standard treatment is percutaneous nephrolithotomy. This surgery has traditionally been performed in the prone position. However, the use of the supine (Valdivia) position is increasing in recent times. Furthermore, the Galdakao-modified supine Valdivia position has been widely used for percutaneous nephrolithotomy since it was described by Ibarluzea et al. in 2007. Treatment of kidney and ureteral stones simultaneously is allowed in both supine positions. In addition, they allow the removal of encrusted stents and the easy placement of double J stents and, in the case of the Galdakao-modified supine Valdivia position, percutaneous nephrostomies. Compartment syndrome is a rare complication in the lithotomy position, but scarcely described in the supine position. This especially applies to the Galdakao-modified supine Valdivia position, in which the lower limbs are in moderate flexion, with the ipsilateral lower limb in a slightly lower position relative to the other. This complication can lead to skin necrosis, myoglobinuric renal failure, amputation, permanent neuromuscular dysfunction, and even death. Risk factors include Body Mass Index, male gender, obesity, increased muscle mass, peripheral vascular disease (advanced age, hypertension, hyperlipidemia and diabetes mellitus), height, lack of operative experience, significant bleeding during surgery, hypothermia, acidemia, combination general-spinal anesthesia, prolonged surgical time, systemic hypotension, ASA (American Society of Anesthesiologists) class or vasoconstrictor drugs. Therefore, compartment syndrome of the leg is a potentially devastating complication that must be suspected and treated through early decompression of the compartment by four compartment fasciotomy. Preventive measures reduce the incidence of this condition.

scholarly journals Sex estimation from dimensions of the fourth lumbar vertebra in Northern Finns of 20, 30, and 46 years of age

2018 ◽  
Vol 290 ◽  
pp. 350.e1-350.e6 ◽  
Author(s):  
Petteri Oura ◽  
Jaro Karppinen ◽  
Jaakko Niinimäki ◽  
Juho-Antti Junno
Keyword(s):  
Lumbar Vertebra ◽  
Sex Estimation ◽  
Fourth Lumbar Vertebra

scholarly journals Small-tract percutaneous nephrolithotomy for an elderly female with renal and ureteral stones complicated by pyogenic kidney

2021 ◽  
Vol 34 ◽  
pp. 101457
Author(s):  
Difu Fan ◽  
Leming Song ◽  
Chunxiang Luo ◽  
Monong Li ◽  
Jack Michel ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Ureteral Stones ◽  
Elderly Female

Intraosseous Schwannoma of the Fourth Lumbar Vertebra: Case Report

Neurosurgery ◽  
1998 ◽  
Vol 43 (5) ◽  
pp. 1219-1222 ◽  
Author(s):  
Chih-Ju Chang ◽  
Jing-Shan Huang ◽  
Yung-Cheng Wang ◽  
Shih-Hung Huang
Keyword(s):  
Case Report ◽  
Lumbar Vertebra ◽  
Intraosseous Schwannoma ◽  
Fourth Lumbar Vertebra

scholarly journals Steinmann Pins and Polymethylmethacrylate Repair of Fourth Lumbar Vertebral Fracture and Dorsocranial Luxation in PuppySteinmann Pins and Polymethylmethacrylate Repair of Fourth Lumbar Vertebral Fracture and Dorsocranial Luxation in Puppy

2020 ◽  
Vol 48 ◽  
Author(s):  
Fernando Bezerra Da Silva Sobrinho ◽  
Ivan Felismino Charas Dos Santos ◽  
Claudia Valéria Seullner Brandão ◽  
Sheila Canevese Rahal ◽  
César Passareli Cândido Lobo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Vertebral Fracture ◽  
Lumbar Vertebrae ◽  
Lumbar Vertebra ◽  
The Body ◽  
Labrador Retriever ◽  
Lumbar Vertebral Fracture ◽  
Cord Injury ◽  
Fourth Lumbar Vertebra

Background: Acute spinal traumas can lead to irreversible damage associated with vascular and inflammatory changes in neural tissue. Since spine and spinal cord traumas have an unfavorable prognosis in small animals, and reports of the use of Steinmann pins and polymethylmethacrylate repair of lumbar vertebra fracture-luxation in puppies are rare in the literature, the present paper aimed to report the surgical treatment of transversal fracture through the body of the fourth lumbar vertebra, with dorsocranial displacement of the caudal fragment by using Steinmann pins and polymethylmethacrylate in a 7-month-old Labrador Retriever male dog.Case: A 7-month-old intact male Labrador Retriever dog, weighing 24.0 kg was attended at School Veterinary Hospital with a history of hit by car and paraplegia of the hind limbs. On neurological examination was observed no proprioception and no deep pain sensitivity on the both pelvic limbs. The lumbar spinal palpation showed intense pain, and the motor function and patellar reflexes were reduced. The values of haematological and biochemical analysis remained within the reference values for the species. Radiographs revealed a transversal fracture through the body of the fourth lumbar vertebra, with dorsocranial displacement of the caudal fragment, and was decided to perform a surgical treatment by open reduction and internal fixation of the fracture. The dog was positioned in ventral recumbency for surgery, and a dorsal midline incision was made from the second lumbar vertebra to the sixth lumbar vertebra. Two crossed 1.5 mm Kirschner wires were placed through the caudal articular facets of the fourth lumbar vertebra to provide initial stability. Two 2.0 mm Steinmann pins were placed at 60° angle of the bodies of the second and fifth lumbar vertebrae, and third and fourth lumbar vertebrae. This procedure was repeated on the other side of the vertebral bodies. Sixty grams of polymethylmethacrylate bone cement was applied and the fixation was checked for stability. Muscular, subcutaneous tissue and skin was closed routinely. The dog was paraplegic without any pain and used a wheelchair to assist in locomotion, although it still had urinary and faecal incontinence; no tail control; and the implants were not removed.Discussion: Lumbar vertebral injuries, as in the present case frequently, occur secondary to severe trauma (e.g. hit by car) and seem to have a characteristic fracture pattern. The patient became paraplegic due to spinal cord injury and failure of sensitivity and elimination of urine and feces which can be associated with progressive destruction of neuronal tissue due to secondary vascular and inflammatory events. The radiographic exam was used to confirm the spinal injury and determine whether by conservative or surgical treatment. The treatment choice is related to the number of fractured compartments, and the presence or not of compression. Fractures in two or more compartments are indicative of surgical treatment, similar as the present case. Use of Steinmann pins was to make a rigid fixing system compared with block plates used for the same function. Use of polymethylmethacrylate may also become a complication due to the infection, for this reason was prescribed an antibiotic for 15 days. This procedure proved to be effective since the dog showed no signs of infection. According to the characteristics of the present case report, the use of Steinmann pins and polymethylmethacrylate for repair of transversal fracture through the body of the fourth lumbar vertebra, with dorsocranial displacement of the caudal fragment provided an effective and practical means of stabilisation, promoting decompression, and thus, improving the patient's quality of life.

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