Summary of Background Data. Determination of normal in vivo motion of the lumbar facet joints remains elusive despite numerous in vitro studies, animal models, and finite element simulations. Alterations in motion of the facet joints have been thought to be associated with various types of lumbar
spine pathology including disc degeneration, facet degeneration, and neural impingement.
Methods. Eleven healthy subjects underwent magnetic resonance imaging (MRI) to obtain three-dimensional models of the lumbar vertebrae from L2-L5. Each patient was then scanned using a dual-fluoroscopic imaging system while positioning the body in different postures: maximal forward-backward bend, side-to-side bending, and maximal left-right torsion. This fluoroscopic set-up was then recreated in solid modeling software where positions of the vertebrae were reproduced at each studied posture by matching the MRI-based models to the MK-4827 nmr fluoroscopic images. The kinematics was measured using a Cartesian coordinate system placed in the center of each facet. The facet orientation in
the sagittal and transverse plane was also determined.
Results. During flexion-extension movements of the trunk, the facet joints rotated primarily along the mediolateral axis (average: 2-6) and were translated in the cephalad caudad direction (average: 2-4 mm). However, during lateral bending and twisting, the facet joints did not rotate or translate in 1 dominant direction. Instead, the resulting motion represented a coupling of rotation and translation in different directions (average: <5 degrees Vorinostat supplier and 3 mm). Further, the kinematic behavior of the facets of the upper lumbar spine check details (L2-L3 and L3-L4) were similar but different from that of the lower lumbar spine (L4-L5).
Conclusion. These findings provide baseline information to enable
the study of kinematic changes that occur in pathologic conditions of the spine and to determine how these might be affected following surgical intervention.”
“Timeliness of response from referral to consultation is necessary to provide best standards of care to inpatients in the general hospital setting.
To measure the length of time from referral to consultation in a liaison psychiatry service, and improve service delivery by introducing guidelines for time to consultation.
Time to consultation was measured on all patients presenting to a liaison psychiatry consultation service over an initial 6-month period, with subsequent repeat measurement following the introduction of guidelines.
There were significant reductions for time to consultation in the service for the second cycle of the audit (chi(2) = 43.84, P < 0.001), and targets based on international standards were achieved.
Introduction of guidelines for time to consultation, may improve response times, leading to improved quality of service for inpatient consultation services.”
“Study Design. Case report.