Journal articles: 'L4'

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Heiser, Gernot, and Kevin Elphinstone. "L4 Microkernels." ACM Transactions on Computer Systems 34, no. 1 (April 6, 2016): 1–29. http://dx.doi.org/10.1145/2893177.

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Scholz, Matti, Philipp Schleicher, and Frank Kandziora. "Instrumented lumbar interbody fusion L4–S1 (TLIF L4–S1)." European Spine Journal 26, S3 (January 23, 2017): 416–17. http://dx.doi.org/10.1007/s00586-016-4934-1.

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Mao, Ren, Rui-Han Tang, Yun Qiu, Bai-Li Chen, Jing Guo, Sheng-Hong Zhang, Xue-Hua Li, et al. "Different clinical outcomes in Crohn’s disease patients with esophagogastroduodenal, jejunal, and proximal ileal disease involvement: is L4 truly a single phenotype?" Therapeutic Advances in Gastroenterology 11 (January 1, 2018): 175628481877793. http://dx.doi.org/10.1177/1756284818777938.

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Background: The Montreal classification defines L4 Crohn’s disease (CD) as any disease location proximal to the terminal ileum, which anatomically includes L4-esophagogastroduodenal (EGD), L4-jejunal, and L4-proximal ileal involvement. L4-jejunal disease was established to be associated with poor prognosis. However, the outcome of patients with L4-proximal ileal disease or L4-EGD remains to be clarified. Our study aimed to investigate whether the outcome differs among CD patients with L4-EGD, L4-jejunal, and L4-proximal ileal disease. Methods: In our retrospective cohort study, 483 patients with confirmed CD were included. The primary outcome was intestinal surgery. Demographic features and outcomes were compared among L4-EGD, L4-jejunal, and L4-proximal ileal disease. Results: Thirty-nine (8.1%) patients had isolated L4 disease, whereas 146 patients had L4 as well as concomitant L1, L2, or L3 disease. During a median follow up of 5.8 years, L4 patients were more likely to have intestinal surgeries compared to non-L4 patients (31% versus 16%, p < 0.001). The percentage of L4-jejunal patients who underwent surgery was higher than that of L4-proximal ileal (66% versus 28%, p < 0.001), and both of these subtypes of L4 were at higher risk for intestinal resection compared to L4-EGD patients (66% and 28% versus 9%, respectively, p < 0.001 and p < 0.05). On multi-variable analysis, L4-jejunal (HR 3.08; 95% CI 1.30–7.31) and L4-proximal ileal disease (HR 1.83; 95% CI 1.07–3.15) were independent predictors for intestinal resection. Conclusions: L4 disease had worse prognosis compared to non-L4 disease. Within L4 disease, phenotype of L4-jejunal and L4-proximal ileal disease indicated higher risk for intestinal surgery. It might be justified to further characterize the L4 phenotype of the Montreal classification into three specific subgroups including L4-EGD, L4-jejunal, and L4-proximal ileal disease, similar to the Paris classification of pediatric patients.

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Zhou, Tian-Hua, Xun Tang, Yong-Qing Xu, and Yue-Liang Zhu. "Traumatic Spondyloptosis of L4." Spine 35, no. 17 (August 2010): E855—E859. http://dx.doi.org/10.1097/brs.0b013e3181d798f2.

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Grobler, L. J., J. E. Novotny, D. G. Wilder, J. W. Frymoyer, and M. H. Pope. "L4–5 Isthmic Spondylolisthesis." Spine 19, Supplement (January 1994): 222–27. http://dx.doi.org/10.1097/00007632-199401001-00018.

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HERRON, LARRY D., and ANTHONY C. TRIPPI. "L4-5 Degenerative Spondylolisthesis." Spine 14, no. 5 (May 1989): 534–38. http://dx.doi.org/10.1097/00007632-198905000-00013.

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Yang, Mu-Zi, Xue Hou, Ji-Bin Li, Jing-Sheng Cai, Jie Yang, Shuo Li, Hao Long, et al. "Impact of L4 lymph node dissection on long-term survival in left-side operable non-small-cell lung cancer: a propensity score matching study." European Journal of Cardio-Thoracic Surgery 57, no. 6 (February 4, 2020): 1181–88. http://dx.doi.org/10.1093/ejcts/ezaa008.

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Abstract OBJECTIVES We investigated the impact of level 4 (L4) lymph node dissection (LND) on overall survival (OS) in left-side resectable non-small-cell lung cancer (NSCLC), with the aim of guiding lymphadenectomy. METHODS A total of 1929 patients with left-side NSCLC who underwent R0 resection between 2001 and 2014 were included in the study. The patients were divided into a group with L4 LND (L4 LND+) and a group without L4 LND (L4 LND−). Propensity score matching was applied to minimize selection bias. The Kaplan–Meier method and Cox proportional hazards model were used to assess the impact of L4 LND on OS. RESULTS A total of 317 pairs were matched. Of the cohort of patients, 20.3% (391/1929) had L4 LND. Of these patients, 11.8% (46/391) presented with L4 lymph node metastasis. L4 lymph node metastasis was not associated with the primary tumour lobes (P = 0.61). Before propensity score matching, the 5-year OS was comparable between the L4 LND+ and L4 LND− groups (69.0% vs 65.2%, P = 0.091). However, after propensity score matching, the 5-year OS of the L4 LND+ group was much improved compared to that of the L4 LND− group (72.9% vs 62.3%, P = 0.002) and L4 LND was an independent factor favouring OS (hazard ratio 0.678, 95% confidence interval 0.513–0.897; P = 0.006). Subgroup analysis suggested that L4 LND was an independent factor favouring OS in left upper lobe tumours. CONCLUSIONS In patients with left-side operable NSCLC, L4 lymph node metastasis was not rare and L4 LND should be routinely performed.

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Morris, Susan J., and Keith N. Leppard. "Adenovirus Serotype 5 L4-22K and L4-33K Proteins Have Distinct Functions in Regulating Late Gene Expression." Journal of Virology 83, no. 7 (January 28, 2009): 3049–58. http://dx.doi.org/10.1128/jvi.02455-08.

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ABSTRACT Adenoviruses express up to 20 distinct mRNAs from five major late transcription unit (MLTU) regions, L1 to L5, by differential splicing and polyadenylation of the primary transcript. MLTU expression is regulated at transcriptional and posttranscriptional levels. The L4-33K protein acts as a splicing factor to upregulate several MLTU splice acceptor sites as the late phase progresses. The L4 region also expresses a 22K protein whose sequence is related to the sequence of L4-33K. L4-22K is shown here also to have an important role in regulating the pattern of MLTU gene expression. An adenovirus genome containing a stop codon in the L4-22K open reading frame expressed low levels of both structural and nonstructural late proteins compared to the wild-type (wt) adenovirus genome; a decrease in intermediate proteins, IVa2 and IX, was also observed. However, early protein synthesis and replication were unaffected by the absence of L4-22K. Intermediate and late protein expression was restored to wt levels by L4-22K expressed in trans but not by L4-33K. Increased MLTU promoter activity, resulting from stabilization of the transcriptional activator IVa2 by L4-22K, made a small contribution to this restoration of late gene expression. However, the principal effect of L4-22K was on the processing of MLTU RNA into specific cytoplasmic mRNA. L4-22K selectively increased expression of penton mRNA and protein, whereas splicing to create penton mRNA is known not to be increased by L4-33K. These results indicate that L4-22K plays a key role in the early-late switch in MLTU expression, additional to and distinct from the role of L4-33K.

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PALMANS V, VAN CALENBERGH F, and VAN LOON J. "Traumatische avulsiefractuur van de ringapofyse L4 bij een patiënt met lysis van L4." Tijdschrift voor Geneeskunde 57, no. 4 (January 1, 2001): 300–304. http://dx.doi.org/10.2143/tvg.57.4.5000977.

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Hodges, Scott D., S. Craig Humphreys, Jason C. Eck, and Laurie A. Covington. "The Surgical Treatment of Far Lateral L3–L4 and L4–L5 Disc Herniations." Spine 24, no. 12 (June 1999): 1243–46. http://dx.doi.org/10.1097/00007632-199906150-00012.

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AKBARI, B., and A. R. MOGHADDAMFAR. "RECOGNIZING BY ORDER AND DEGREE PATTERN OF SOME PROJECTIVE SPECIAL LINEAR GROUPS." International Journal of Algebra and Computation 22, no. 06 (August 31, 2012): 1250051. http://dx.doi.org/10.1142/s0218196712500518.

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Let M be a finite group and D (M) be the degree pattern of M. Denote by h OD (M) the number of isomorphism classes of finite groups G with the same order and degree pattern as M. A finite group M is called k-fold OD-characterizable if h OD (M) = k. Usually, a 1-fold OD-characterizable group is simply called OD-characterizable. The purpose of this article is twofold. First, it provides some information on the structure of a group from its degree pattern. Second, it proves that the projective special linear groups L4(4), L4(8), L4(9), L4(11), L4(13), L4(16), L4(17) are OD-characterizable.

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Ma, Sangyeol, Wontae Gong, and Hyolyun Ro. "The Correlations between Lumbar Lordosis, L4-5 Disc Angle, L4-5 Disc Height, and the Lumbosacral Angle in L4-5 HNP Patients." Journal of Physical Therapy Science 22, no. 4 (2010): 391–94. http://dx.doi.org/10.1589/jpts.22.391.

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Ding, Huaili, Lijun Liao, Peichun Yan, Xiaolin Zhao, and Min Li. "Three-Dimensional Finite Element Analysis of L4-5 Degenerative Lumbar Disc Traction under Different Pushing Heights." Journal of Healthcare Engineering 2021 (July 19, 2021): 1–9. http://dx.doi.org/10.1155/2021/1322397.

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Objective. To study and analyze the changes of intervertebral foramen height and area of the degenerative L4-5 intervertebral disc under different pushing heights by the finite element method. Methods. CT and MRI images of T12-S1 segments were obtained from a healthy volunteer who met the inclusion criteria. A DR machine was used to capture images of the lumbar lateral section before and after simultaneous pushing of the L4 and L5 spinous processes by manipulation called Daogaijinbei, and the measurement showed that the displacement changes of L4 and L5 were both approximately 10 cm, so the pushing height was set at 0–10 cm. A three-dimensional finite element model of the entire normal lumbar spine was established using Mimics 16.0, Geomagic Studio 2014, Hypermesh 13.0, MSC.Patran 2012, and so on. The disc height and nucleus area of the lumbar disc of the normal entire lumbar disc model were adjusted to establish models of the L4-5 disc with mild, moderate, and severe degeneration. Changes of disc height and area of the L4-5 degenerative intervertebral disc under different pushing heights were calculated. Results. The size of the L4-5 intervertebral foramen was analyzed from the height and area of the intervertebral foramen, and the results showed the following: (1) as for the normal lumbar disc and a lumbar of the L4-5 disc with mild and moderate degeneration, the height of the L4-5 intervertebral foramen and its area both increased during pushing between 0 and 8 cm. After the pushing height reached 8 cm, the height and area of the L4-5 intervertebral foramen gradually became stable; (2) as for the L4-5 disc with severe degeneration, during the process of pushing, the height and area of the L4-5 intervertebral foramen increased slightly, but this change was not obvious. Conclusions. After the spinal manipulation, the sizes of the L4-5 intervertebral foramen of the L4-5 disc with mild and moderate degeneration were significantly larger than those before pushing; in contrast, the size of L4-5 intervertebral foramen of the L4-5 disc with severe lumbar degeneration was not significantly changed.

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Inoue, Yoshihiro, Satoshi Shidahara, Yoshihiro Yamaguchi, Hideaki Abe, and Kazuyuki Takamura. "Schwannoma of the L4 Root." Orthopedics & Traumatology 40, no. 1 (1991): 191–93. http://dx.doi.org/10.5035/nishiseisai.40.191.

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F. McLain, Robert, Scott A. Yerby, and Timothy A. Moseley. "Comparative Morphometry of L4 Vertebrae." Spine 27, no. 8 (April 2002): E200—E206. http://dx.doi.org/10.1097/00007632-200204150-00005.

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Telli Erdogan, Secil, Gulhan Ertan Akan, Afak Durur Karakaya, and Cengiz Erol. "Non-traumatic L4-L5 spondyloptosis." Spine Journal 16, no. 10 (October 2016): e671-e672. http://dx.doi.org/10.1016/j.spinee.2016.03.001.

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Robertson, Peter A., Leon J. Grobler, John E. Novotny, and Jeffrey N. Katz. "Postoperative Spondylolisthesis at L4-5." Spine 18, no. 11 (September 1993): 1483–90. http://dx.doi.org/10.1097/00007632-199309010-00013.

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Robertson, Peter A., Leon J. Grobler, John E. Novotny, and Jeffrey N. Katz. "Postoperative Spondylolisthesis at L4-5." Spine 18, no. 11 (September 1993): 1483–90. http://dx.doi.org/10.1097/00007632-199318110-00013.

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Torebjörk, E. "L4 Neurophysiological aspects of pain." Electroencephalography and Clinical Neurophysiology 99, no. 4 (October 1996): 343. http://dx.doi.org/10.1016/0013-4694(96)88436-7.

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Lee, SoJung, Ian Janssen, and Robert Ross. "Interindividual variation in abdominal subcutaneous and visceral adipose tissue: influence of measurement site." Journal of Applied Physiology 97, no. 3 (September 2004): 948–54. http://dx.doi.org/10.1152/japplphysiol.01200.2003.

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We evaluated the influence of measurement site on the ranking (low to high) of abdominal subcutaneous (SAT) and visceral (VAT) adipose tissue. We also determined the influence of measurement site on the prediction of abdominal SAT and VAT mass. The subjects included 100 men with computed tomography (CT) measurements at L4–L5 and L3–L4 levels and 100 men with magnetic resonance imaging (MRI) measurements at L4–L5 and 5 cm above L4–L5 (L4–L5 +5 cm). Corresponding mass values were determined by using multiple-image protocols. For SAT, 90 and 92 of the 100 subjects for CT and MRI, respectively, had a difference in rank position at the two levels. The change in rank position exceeded the error or measurement for ∼75% of the subjects for both methods. For VAT, 91 and 95 of the 100 subjects for CT and MRI, respectively, had a difference in rank position at the two levels. The change in rank position exceeded the error of measurement for 36% of the subjects for CT and for 8% of the subjects for MRI. For both imaging modalities, the variance explained in SAT and VAT mass (kg) was comparable for L4–L5, L4–L5 +5 cm, and L3–L4 levels. In conclusion, the ranking of subjects for abdominal SAT and VAT quantity is influenced by measurement location. However, the ability to predict SAT and VAT mass by using single images obtained at the L4–L5, L4–L5 +5 cm, or L3–L4 levels is comparable.

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Kim, Hong Tae, Bong Hoon Park, Dong Wook Cheon, Hyug Su An, and Hyung Seok Lee. "A Comparative Study of the Floating L4-5) vs Lumbosacral L4-S1) Spinal Fusions." Journal of the Korean Orthopaedic Association 29, no. 4 (1994): 1151. http://dx.doi.org/10.4055/jkoa.1994.29.4.1151.

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Guo, Machao, Chao Kong, Siyuan Sun, Xiangyao Sun, Xiangyu Li, and Shibao Lu. "Predictors of L4−L5 Degenerative Lumbar Spondylolisthesis: L4 Inclination Angle and Facet Joint Angle." World Neurosurgery 130 (October 2019): e680-e686. http://dx.doi.org/10.1016/j.wneu.2019.06.188.

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Zengel, J. M., and L. Lindahl. "Ribosomal protein L4 of Escherichia coli: in vitro analysis of L4-mediated attenuation control." Biochimie 73, no. 6 (June 1991): 719–27. http://dx.doi.org/10.1016/0300-9084(91)90052-3.

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Koyuncu, Orkide Ö, and Thomas Dobner. "Arginine Methylation of Human Adenovirus Type 5 L4 100-Kilodalton Protein Is Required for Efficient Virus Production." Journal of Virology 83, no. 10 (March 4, 2009): 4778–90. http://dx.doi.org/10.1128/jvi.02493-08.

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ABSTRACT The adenovirus type 5 (Ad5) late region 4 (L4) 100-kDa nonstructural protein (L4-100K) mediates inhibition of cellular protein synthesis and selective translation of tripartite leader (TL)-containing viral late mRNAs via ribosome shunting. In addition, L4-100K has been implicated in the trimerization and nuclear localization of hexon protein. We previously proved that L4-100K is a substrate of the protein arginine methylation machinery, an emergent posttranslational modification system involved in a growing list of cellular processes, including transcriptional regulation, cell signaling, RNA processing, and DNA repair. As understood at present, L4-100K arginine methylation involves protein arginine methyltransferase 1 (PRMT1), which asymmetrically dimethylates arginines embedded in arginine-glycine-glycine (RGG) or glycine-arginine-rich (GAR) domains. To identify the methylated arginine residues and assess the role of L4-100K arginine methylation, we generated amino acid substitution mutations in the RGG and GAR motifs to examine their effects in Ad-infected and plasmid-transfected cells. Arginine-to-glycine exchanges in the RGG boxes significantly diminished L4-100K methylation in the course of an infection and substantially reduced virus growth, demonstrating that L4-100K methylation in RGG motifs is an important host cell function required for efficient Ad replication. Our data further indicate that PRMT1-catalyzed arginine methylation in the RGG boxes regulates the binding of L4-100K to hexon and promotes the capsid assembly of the structural protein as well as modulating TL-mRNA interaction. Furthermore, substitutions in GAR, but not RGG, regions affected L4-100K nuclear import, implying that the nuclear localization signal of L4-100K is located within the GAR sequence.

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Yu, Guoliang, Ian Segel, Zhiyong Zhang, Quinn H. Hogan, and Bin Pan. "Dorsal Root Ganglion Stimulation Alleviates Pain-related Behaviors in Rats with Nerve Injury and Osteoarthritis." Anesthesiology 133, no. 2 (May 18, 2020): 408–25. http://dx.doi.org/10.1097/aln.0000000000003348.

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Background Dorsal root ganglion field stimulation is an analgesic neuromodulation approach in use clinically, but its mechanism is unknown as there is no validated animal model for this purpose. The authors hypothesized that ganglion stimulation is effective in reducing pain-like behaviors in preclinical chronic pain models. Methods The authors provided ganglion stimulation or spinal cord stimulation to rats with traumatic neuropathy (tibial nerve injury), or osteoarthritis induced by intraarticular knee monosodium iodoacetate, or without injury (naïve). Analgesia was evaluated by testing a battery of pain-related reflexive, functional, and affective behaviors. Results In rats with nerve injury, multilevel L4 and L5 ganglion stimulation decreased hypersensitivity to noxious mechanical stimulation more (area under curve, −1,447 ± 423 min × % response; n = 12) than single level ganglion stimulation at L4 ([−960 ± 251 min × % response; n = 8; P = 0.012] vs. L4 and L5), and L5 ([−676 ± 295 min × % response; n = 8; P < 0.0001] vs. L4 and L5). Spontaneous pain-like behavior, evaluated by conditioned place preference, responded to single L4 (Pretest [−93 ± 65 s] vs. Test [87 ± 82 s]; P = 0.002; n = 9), L5 (Pretest [−57 ± 36 s] vs. Test [137 ± 73 s]; P = 0.001; n = 8), and multilevel L4 and L5 (Pretest: −81 ± 68 s vs. Test: 90 ± 76 s; P = 0.003; n = 8) ganglion stimulation. In rats with osteoarthritis, multilevel L3 and L4 ganglion stimulation reduced sensitivity to knee motion more (−156 ± 28 min × points; n = 8) than L3 ([−94 ± 19 min × points in knee bend test; n = 7; P = 0.002] vs. L3 and L4) or L4 ([−71 ± 22 min × points; n = 7; P < 0.0001] vs. L3 and L4). Conditioned place preference during osteoarthritis revealed analgesic effectiveness for ganglion stimulation when delivered at L3 (Pretest [−78 ± 77 s] vs. Test [68 ± 136 s]; P = 0.048; n = 9), L4 (Pretest [−96 ± 51 s] vs. Test [73 ± 111 s]; P = 0.004; n = 9), and L3 and L4 (Pretest [−69 ± 52 s; n = 7] vs. Test [55 ± 140 s]; P = 0.022; n = 7). Conclusions Dorsal root ganglion stimulation is effective in neuropathic and osteoarthritic preclinical rat pain models with peripheral pathologic origins, demonstrating effectiveness of ganglion stimulation in a placebo-free setting and justifying this model as a suitable platform for mechanistic studies. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Fontes, Ricardo B. V., and Vincent C. Traynelis. "Iliac crest osteotomy to enhance exposure of the L4–5 interspace in minimally invasive lateral transpsoas interbody fusion: a cadaveric feasibility study." Journal of Neurosurgery: Spine 18, no. 1 (January 2013): 13–17. http://dx.doi.org/10.3171/2012.10.spine12311.

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Object Minimally invasive lateral transpsoas interbody fusion (LTIF) has emerged as a popular surgical technique in a remarkably short period of time. The authors' experience with this procedure and anecdotal evidence in the literature suggest that the iliac crest may occasionally prevent access to the L4–5 interspace during minimally invasive LTIF. The authors propose that removal of a minimal amount of ilium would allow for successful exposure of the L4–5 interspace in those cases with a “high-riding” iliac crest. Therefore, the objective of this study was to evaluate the feasibility of iliac osteotomy to enhance exposure of the L4–5 interspace for minimally invasive LTIF. Methods Twenty L4–5 minimally invasive LTIF procedures were performed on 10 cadavers. The L4–5 minimally invasive LTIFs were successfully completed in 13 of 20 attempts. In the remaining 7 cases, the iliac crest prevented perfect orthogonal access to the L4–5 interspace. An iliac osteotomy was performed until the tubular retractors could be perfectly aligned with the L4–5 interspace and minimally invasive LTIF accomplished. Anteroposterior fluoroscopic images were obtained before and after the osteotomies. The angle between the working instrument and the superior L-5 endplate was measured, as were craniocaudal displacement and the resected iliac area. Results Iliac osteotomy enabled completion of L4–5 minimally invasive LTIF in the 7 remaining cases. Iliac resection was minimal; an average of 4.92 cm2 of iliac surface was resected (range 2.08–8.27 cm2) to enable L4–5 access. Adequate working angles were maintained (average 3.3° change after resection) while significant caudal displacement of the tubular system was achieved (average 15.7 mm, range 5.2–27.6 mm). Conclusions A significant portion of patients may have a high-riding iliac crest and that may have had an impact on minimally invasive LTIF in this series; L4–5 cases are rare in relation to midlumbar spine cases in most minimally invasive LTIF patient series. Significant caudal displacement of the tubular system was achieved with minimal iliac osteotomy, ensuring access to the L4–5 interspace in all specimens while maintaining the minimally invasive philosophy behind minimally invasive LTIF.

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Gao, Congxiao, Reiko Fujinawa, Takayuki Yoshida, Manabu Ueno, Fumi Ota, Yasuhiko Kizuka, Tetsuya Hirayama, et al. "A keratan sulfate disaccharide prevents inflammation and the progression of emphysema in murine models." American Journal of Physiology-Lung Cellular and Molecular Physiology 312, no. 2 (February 1, 2017): L268—L276. http://dx.doi.org/10.1152/ajplung.00151.2016.

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Emphysema is a typical component of chronic obstructive pulmonary disease (COPD), a progressive and inflammatory airway disease. However, no effective treatment currently exists. Here, we show that keratan sulfate (KS), one of the major glycosaminoglycans produced in the small airway, decreased in lungs of cigarette smoke-exposed mice. To confirm the protective effect of KS in the small airway, a disaccharide repeating unit of KS designated L4 ([SO3−-6]Galβ1–4[SO3−-6]GlcNAc) was administered to two murine models: elastase-induced-emphysema and LPS-induced exacerbation of a cigarette smoke-induced emphysema. Histological and microcomputed tomography analyses revealed that, in the mouse elastase-induced emphysema model, administration of L4 attenuated alveolar destruction. Treatment with L4 significantly reduced neutrophil influx, as well as the levels of inflammatory cytokines, tissue-degrading enzymes (matrix metalloproteinases), and myeloperoxidase in bronchoalveolar lavage fluid, suggesting that L4 suppressed inflammation in the lung. L4 consistently blocked the chemotactic migration of neutrophils in vitro. Moreover, in the case of the exacerbation model, L4 inhibited inflammatory cell accumulation to the same extent as that of dexamethasone. Taken together, L4 represents one of the potential glycan-based drugs for the treatment of COPD through its inhibitory action against inflammation.

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Gracitelli, Mauro Emilio Conforto, Danilo Ricardo Okishi de Oliveira, Henrique Mennucci de Haidar Jorge, Marcelo Poderoso de Araújo, Tarcísio Eloy Pessoa de Barros Filho, Reginaldo Perilo Oliveira, Alexandre Sadao Iutaka, Alexandre Fogaça Cristante, Douglas Kenji Narazaki, and Leonardo dos Santos Correia. "Mapeamento do trajeto extraforaminal da raiz L4 no espaço intertransversário L4-L5 através do acesso paramediano à coluna vertebral." Acta Ortopédica Brasileira 14, no. 5 (2006): 246–48. http://dx.doi.org/10.1590/s1413-78522006000500002.

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As hérnias discais extremolaterais correspondem a 10% das hérnias discais sintomáticas, mais comumente localizadas nos níveis L3-L4 e L4-L5. Por muitos anos, a abordagem cirúrgica das hérnias lombares foraminais e extraforaminais foi feita através de via de acesso posterior mediana com hemilaminectomia e facetectomia total ou parcial. Inúmeras foram as variações propostas para essa técnica a fim de se evitar a facetectomia e suas repercussões biomecânicas, que ocasionavam com certa freqüência o surgimento de dor lombar baixa devido à instabilidade vertebral criada. A abordagem cirúrgica dessa patologia pela via paramediana, entre os músculos multífido e longuíssimo (via de Wiltse), tem a vantagem de poupar o paciente de perdas ósseas e permitir uma visão mais oblíqua do neuro-foramen. Essa abordagem permite, com mínima mobilização da raiz de L4, acesso ao disco L4-L5 e eventuais herniações extra-foraminais do mesmo. Nosso objetivo é apresentar um estudo do trajeto extra-foraminal da raiz de L4 no espaço intertransversário L4-L5. Para isso, foram realizadas dissecções em 10 cadáveres (20 lados) e obtidas as medidas baseadas em 6 parâmetros anatômicos. A análise dos dados nos permite concluir que as hérnias discais extremo-laterais no nível L4-L5 podem ser acessadas com relativa segurança através da via paramediana.

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Maruszewska-Cheruiyot, Marta, Katarzyna Donskow-Łysoniewska, Katarzyna Krawczak, Ludmiła Szewczak, Ewa Joachimiak, and Maria Doligalska. "The intestinal milieu influences the immunoproteome of male and female Heligmosomoides polygyrus bakeri L4 stage." Parasitology 147, no. 13 (July 30, 2020): 1480–87. http://dx.doi.org/10.1017/s0031182020001201.

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AbstractThe gastrointestinal nematode Heligmosomoides polygyrus bakeri shows enhanced survival in mice with colitis. As the antibody response plays an important role in antiparasitic immunity, antibodies against male and female L4 H. polygyrus were examined in mice with and without colitis. Levels of specific antibodies in the mucosa and serum were determined by enzyme-linked immunosorbent assay and immunogenic proteins of male and female parasites were identified using 2D electrophoresis and mass spectrometry. The function of identified proteins was explored with Blast2Go. Nematodes in mice with colitis induced higher levels of specific immunoglobulin G (IgG1) and IgA, a lower level of IgE in the small intestine and a higher level of IgE in serum against female L4. Infected mice with colitis recognized 12 proteins in male L4 and 10 in female L4. Most of the recognized proteins from male L4 were intermediate filament proteins, whereas the proteins from female L4 were primarily actins and galectins. Nematodes from mice with colitis were immunogenically different from nematodes from control mice. This phenomenon gives new insights into helminth therapy as well as host–parasite interactions.

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Łopieńska-Biernat, E., K. Żółtowska, and J. Rokicki. "Glycogen catabolism enzymes and protein fractions in the third and fourth larval stages ofAnisakis simplex." Journal of Helminthology 82, no. 1 (March 2008): 45–51. http://dx.doi.org/10.1017/s0022149x0787355x.

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AbstractExtracts ofAnisakis simplexthird (L3) and fourth (L4) larval stages were assayed for protein content and activity and properties of α-amylase, glucoamylase and glycogen phosphorylase. Protein content in L4 was twice that in L3. SDS–PAGE applied to both larval stages revealed 22 protein fractions in each, including five stage-specific fractions in each larval stage. The L3 extracts contained three amylase isoenzymes: α1, α2 and α3; their molecular weights were 64, 29 and 21 kDa, respectively. Only one amylase isoenzyme (64 kDa) was found in the L4 extracts. Glycogen in L3 was found to be broken down mostly by hydrolysis because of low glycogen phosphorylase activity. The α-amylase activity in L4 was higher than that in L3 by half and the glycogen phosphorylase activity was ten times higher. In addition, the same enzymes isolated from L3 and L4 were found to differ in their properties. These differences could be manifestations of metabolic adaptations ofA. simplexlarvae to host switch from fish (L3) to mammals (L4), i.e. adaptations to a new habitat.

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Islas, Daniel Alberto Ramírez, and José María Jiménez Ávila. "L4 fractures, biomechanics of cure foretold." Coluna/Columna 13, no. 4 (December 2014): 315–17. http://dx.doi.org/10.1590/s1808-18512014130400475.

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Objectives: To analyze the clinical and radiographic outcomes in fracture of the fourth lumbar vertebra, under conservative or surgical treatment. Methods: Patients diagnosed with L4 fracture with or without neurological injury were studied and to whom conservative or surgical treatment was provided. Radiographic measurements were performed taking into account the kyphosis angle, the sagittal index, loss of vertebral body height, percentage of canal occlusion and height compression percentage. Results: Twenty-five patients were treated, five conservatively and 20 surgically. The vertebral kyphosis angle in both groups was 12°, no regional kyphosis was present, the sagittal index was 11.9 (Farcy), the loss of vertebral body height was 53.17%, the percentage of canal occlusion was 23% and the height compression percentage was 38.06%. The residual pain according to the visual analog scale was two in both groups. Conclusions: Patients with a fractured L4 have a satisfactory outcome with both treatments, the height of the vertebral body remains the same, the lordosis is preserved and therefore the sagittal balance, allowing recovering the mechanical functions of the spine as opposed to other segment fractures.

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Voltolini, Chiara, Romina Novembri, Alberto Imperatore, Michela Torricelli, John Challis, and Felice Petraglia. "L4. Placental inflammatory factors and preeclampsia." Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health 1, no. 3-4 (July 2011): 240. http://dx.doi.org/10.1016/j.preghy.2011.08.005.

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Ahmed, Abrar, B. H. Mahesh, Prasoon K. Shamshery, and Arvind Jayaswal. "Traumatic Retrolisthesis of the L4 Vertebra." Journal of Trauma: Injury, Infection, and Critical Care 58, no. 2 (February 2005): 393–94. http://dx.doi.org/10.1097/01.ta.0000073998.94089.d1.

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Colangelo, G., J. Gasser, and A. Rusetsky. "Isospin breaking in K l4 decays." European Physical Journal C 59, no. 4 (December 18, 2008): 777–93. http://dx.doi.org/10.1140/epjc/s10052-008-0818-9.

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Ng, Julia Poh-Hwee, Arun-Kumar Kaliya-Perumal, Ankit Anil Tandon, and Jacob Yoong-Leong Oh. "The Oblique Corridor at L4-L5." SPINE 45, no. 10 (May 2020): E552—E559. http://dx.doi.org/10.1097/brs.0000000000003346.

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Aledo, Juan A., José A. Gálvez, and Pablo Mira. "Isometric immersions of L2 into L4." Differential Geometry and its Applications 24, no. 6 (December 2006): 613–27. http://dx.doi.org/10.1016/j.difgeo.2006.04.006.

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Brody, F., M. Rosen, M. Tarnoff, and I. Lieberman. "Laparoscopic lateral L4–L5 disc exposure." Surgical Endoscopy 16, no. 4 (December 10, 2001): 650–53. http://dx.doi.org/10.1007/s00464-001-8195-6.

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Deniz, Fatih Ersay, Mehmet Zileli, Sedat Çağlı, and Hasan Kanyılmaz. "Traumatic L4–L5 spondylolisthesis: case report." European Spine Journal 17, S2 (September 22, 2007): 232–35. http://dx.doi.org/10.1007/s00586-007-0496-6.

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Sanderson, Scott P., John Houten, Thomas Errico, David Forshaw, Joel Bauman, and Paul R. Cooper. "The Unique Characteristics of “Upper” Lumbar Disc Herniations." Neurosurgery 55, no. 2 (August 1, 2004): 385–89. http://dx.doi.org/10.1227/01.neu.0000129548.14898.9b.

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Abstract OBJECTIVE: To compare the characteristics, presentation, and surgical outcome of patients with microdiscectomies at L1–L2 and L2–L3 with those we treated at L3–L4. We further sought to compare these results with those reported in the literature for discectomies at the L4–L5 and L5–S1 levels. METHODS: We reviewed the clinical data collected from 69 patients who had 72 L1–L2, L2–L3, and L3–L4 microdiscectomies performed from 1989 to 1999 at the New York University Medical Center. Patients who had surgery at L1–L2 or L2–L3 were grouped and compared with those treated at the L3–L4 level. Patients' charts were retrospectively reviewed at a mean of 12.9 months after surgery for presenting signs and symptoms, patient characteristics, and surgical outcome. Long-term follow-up via telephone interview was obtained at an average of 81.3 months after surgery. RESULTS: In the L1–L2 + L2–L3 group, 58% of the patients had previous lumbar disc surgery, compared with only 10% of those in the L3–L4 group, and 20% in the L1–L2 + L2–L3 group required a fusion during the procedure compared with only 10% in the L3–L4 group. These differences are both statistically significant. The short-term chart review demonstrates that only 58% and 53% of patients in the L1–L2 + L2–L3 group were improved with regard to radicular and back pain, respectively, whereas those in the L3–L4 group reported 94 and 87% rates of improvement in the same categories, both highly statistically significant findings. The long-term follow-up confirmed a highly statistically significantly worse outcome in the L1–L2 + L2–L3 group, with only 33% of patients reporting an improvement in their economic or functional status, compared with an 88% rate of improvement in the L3–L4 group. The outcome of our patients with L3–L4 herniations was similar to that reported in the literature for herniations at L4–L5 and L5–S1. CONCLUSION: Herniated discs at the L1–L2 or L2–L3 level are different entities from those at lower levels of the lumbar spine. The surgical outcome in terms of postoperative back and radicular pain is worse for herniated discs at L1–L2 and L2–L3 compared with those treated at L3–L4. Our patients with L1–L2 or L2–L3 surgically treated herniated discs were more likely to have had previous lumbar surgery and required a fusion more often than their counterparts with L3–L4 herniated discs.

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Biasiotto, Roberta, and Göran Akusjärvi. "Regulation of Human Adenovirus Alternative RNA Splicing by the Adenoviral L4-33K and L4-22K Proteins." International Journal of Molecular Sciences 16, no. 2 (January 28, 2015): 2893–912. http://dx.doi.org/10.3390/ijms16022893.

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Goodman, Bradly S., Sean C. Stehr, and Pooja Agarwal. "Inadvertent bilateral L3/L4 zygapophyseal joint injection during a right L3/L4 interlaminar epidural steroid injection." Spine Journal 11, no. 11 (November 2011): 1078. http://dx.doi.org/10.1016/j.spinee.2011.10.014.

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Wright, Jordan, Zeenah Atwan, Susan J. Morris, and Keith N. Leppard. "The Human Adenovirus Type 5 L4 Promoter Is Negatively Regulated by TFII-I and L4-33K." Journal of Virology 89, no. 14 (April 29, 2015): 7053–63. http://dx.doi.org/10.1128/jvi.00683-15.

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ABSTRACTThe late phase of adenovirus gene expression is controlled by proteins made in the intermediate phase, including L4 proteins of 22,000- and 33,000-Da apparent molecular mass (L4-22K and -33K proteins) that are expressed initially from the L4 promoter (L4P). The L4P is activated by a combination of viral proteins and cellular p53 and is ultimately inhibited again by its own products. Here, we have examined the L4P of human adenovirus type 5 in detail and have defined its transcription start site, which our data suggest is positioned by a weak TATA box. Rather than contributing positively to promoter activity, a putative initiator element at the transcription start site acts as a target for negative regulation imposed on the L4P by cellular TFII-I. We show that this TFII-I inhibition is relieved by one of the previously defined viral activators of the L4P, the E4 Orf3 protein, which alters the pool of TFII-I in the cell. We also explore further the negative regulation of the L4P by its products and show that the L4-33K protein is more significant in this process than L4-22K. It is the combined actions of positive and negative factors that lead to the transient activation of the L4P at the onset of the late phase of adenovirus gene expression.IMPORTANCEThe adenovirus replication cycle proceeds through multiple phases of gene expression in which a key step is the activation of late-phase gene expression to produce proteins from which progeny particles can be formed. Working with human adenovirus type 5, we showed previously that two proteins expressed from the L4 region of the viral genome perform essential roles in moving the infection on into the late phase; these two proteins are produced by the action of a dedicated promoter, the L4P, and without them the infection does not proceed successfully to progeny generation. In this new work, we delineate further aspects of L4P activity and regulation. Understanding how the L4P works, and how it contributes to activation of the late phase of infection, is important to our understanding of natural infections by the virus, in which late gene expression can fail to occur, allowing the virus to persist.

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Constantinople, Christine M., and Randy M. Bruno. "Deep Cortical Layers Are Activated Directly by Thalamus." Science 340, no. 6140 (June 27, 2013): 1591–94. http://dx.doi.org/10.1126/science.1236425.

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The thalamocortical (TC) projection to layer 4 (L4) is thought to be the main route by which sensory organs communicate with cortex. Sensory information is believed to then propagate through the cortical column along the L4→L2/3→L5/6 pathway. Here, we show that sensory-evoked responses of L5/6 neurons in rats derive instead from direct TC synapses. Many L5/6 neurons exhibited sensory-evoked postsynaptic potentials with the same latencies as L4. Paired in vivo recordings from L5/6 neurons and thalamic neurons revealed substantial convergence of direct TC synapses onto diverse types of infragranular neurons, particularly in L5B. Pharmacological inactivation of L4 had no effect on sensory-evoked synaptic input to L5/6 neurons. L4 is thus not an obligatory distribution hub for cortical activity, and thalamus activates two separate, independent “strata” of cortex in parallel.

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Schwenger-Erger, Claudia, Wolfgang Barz, and Nikolaus Weber. "Fatty Acid Alteration of Plastidic and Extra-Plastidic Membrane Lipids in Metribuzin-Resistant Photoautotrophic Chenopodium rubrum Cells as Compared to Wild-Type Cells." Zeitschrift für Naturforschung C 56, no. 11-12 (December 1, 2001): 1047–56. http://dx.doi.org/10.1515/znc-2001-11-1223.

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Abstract The fatty acid compositions of plastidic and extra-plastidic membrane lipids of two metri-buzin-resistant cell lines L4 and L7 of C henopodium rubrum were determined after growth in the absence and in the presence of the herbicide and compared with those o f wild type cells. Fatty acid biosynthesis was markedly affected in all cell lines by metribuzin treatment. In the absence and in the presence of metribuzin alterations of the fatty acid com position of the various lipid classes were, as compared to wild type cells, generally lower in the highly resistant L4 cells than in the less resistant L7 cells. The two resistant cell lines demonstrated a higher degree of unsaturation within the plastidic monogalactosyldiacylglycerols (L4 cells also within plastidic digalactosyldiacylglycerols) and, particularly, within the predominantly extra-plastidic phosphatidylcholines (L7 cells also within the predominantly extra-plastidic phosphatidylethanolamines), whereas the degree of unsaturation was slightly altered in the plastidic phosphatidylglycerols. Within the two metribuzin-resistant cell lines, the highly resis tant L4 cells differed from the less resistant L7 cells by increased a-linolenic acid/palmitic acid ratios in both the plastidic and extra-plastidic membrane lipids suggesting that particu larly in L4 cells higher proportions of linolenate are formed as a result o f selection pressure. On the other hand, the proportion of linoleate was increased predominantly in extra-plastidic membrane lipids of both L4 and L7 cells which explains a raise in linoleic acid/palmitic acid ratios in both cell lines as compared to wild-type cells. Moreover, in the absence of metri buzin decreased proportions o f fram-3-hexadecenoic acid were found in phosphatidylglycer ols of L4 and, particularly, of L7 cells as compared to the wild type cells. It is suggested that L4 and L7 cells -having multiple mutations in the psbA gene as observed earlier -are additionally characterized by increased degree of unsaturation of acyl moieties in various polar lipids, e.g. linoleoyl moieties in L4 and L7 cells as well as linolenoyl moieties particularly in highly resistant L4 cells. This increase gives rise to a change in membrane fluidity and may finally lead to increased metribuzin resistance.

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McClelland, Shearwood, and Stefan S. Kim. "Successful operative management of an upper lumbar spinal canal stenosis resulting in multilevel lower nerve root radiculopathy." Journal of Neurosciences in Rural Practice 6, no. 01 (January 2015): 108–11. http://dx.doi.org/10.4103/0976-3147.143216.

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ABSTRACTLumbar stenosis is a common disorder, usually characterized clinically by neurogenic claudication with or without lumbar/sacral radiculopathy corresponding to the level of stenosis. We present a case of lumbar stenosis manifesting as a multilevel radiculopathy inferior to the nerve roots at the level of the stenosis. A 55-year-old gentleman presented with bilateral lower extremity pain with neurogenic claudication in an L5/S1 distribution (posterior thigh, calf, into the foot) concomitant with dorsiflexion and plantarflexion weakness. Imaging revealed grade I spondylolisthesis of L3 on L4 with severe spinal canal stenosis at L3-L4, mild left L4-L5 disc herniation, no stenosis at L5-S1, and no instability. EMG revealed active and chronic L5 and S1 radiculopathy. The patient underwent bilateral L3-L4 hemilaminotomy with left L4-L5 microdiscectomy for treatment of his L3-L4 stenosis. Postoperatively, he exhibited significant improvement in dorsiflexion and plantarflexion. The L5-S1 level was not involved in the operative decompression. Patients with radiculopathy and normal imaging at the level corresponding to the radiculopathy should not be ruled out for operative intervention should they have imaging evidence of lumbar stenosis superior to the expected affected level.

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Araújo, Marcelo Poderoso de, Ronald Bispo Barreto da Silva, Leandro Ejnisman, Tarcísio Eloy Pessoa de Barros Filho, Reginaldo Perilo Oliveira, Alexandre Fogaça Cristante, and Alexandre Sadao Iutaka. "Avaliação da relação entre parâmetros antropométricos (peso e altura) e a topografia da raiz de L4 no espaço intertransversário L4-L5 através do acesso paramediano à coluna vertebral- Um estudo anatômico em vinte e um cadáveres." Acta Ortopédica Brasileira 16, no. 2 (2008): 98–101. http://dx.doi.org/10.1590/s1413-78522008000200007.

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As hérnias discais extremolaterais correspondem a 10% das hérnias discais sintomáticas, mais comumente localizadas nos níveis L3-L4 e L4-L5. Por muitos anos, a abordagem cirúrgica das hérnias lombares foraminais e extraforaminais foi feita através de via de acesso posterior mediana com hemilaminectomia e facetectomia total ou parcial. A abordagem cirúrgica dessa patologia pela via paramediana, entre os músculos multífido e longuíssimo (via de Wiltse), tem a vantagem de poupar o paciente de perdas ósseas e permitir uma visão mais oblíqua do neuro-foramen. Essa abordagem permite, com mínima mobilização da raiz de L4, acesso ao disco L4-L5 e eventuais herniações extra-foraminais do mesmo. Nosso objetivo é avaliar se há relação entre características antropométricas de um indivíduo e a localização da raiz de L4 no espaço intertransversário, acessado pela via de Wiltse, para com isso poder antecipar alguns riscos cirúrgicos. Foram realizadas dissecções em 21 cadáveres (42 lados) e obtidas as respectivas medidas de peso e altura além da distância entre a base do processo transverso de L5 e o ponto onde a raiz de L4 o cruza. A análise dos dados nos permite concluir que não há relação estatisticamente significativa entre as variáveis envolvidas.

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ALMUDEVAR, ANTHONY. "A NOTE ON THE CALCULATION OF N-STATISTICS." Journal of Bioinformatics and Computational Biology 07, no. 05 (October 2009): 895–903. http://dx.doi.org/10.1142/s0219720009004382.

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A class of statistics suitable for testing against equality of multivariate distributions is described by Klebanov and co-workers in 2007. Referred to as N-statistics, their discriminating ability is based on various forms of distance kernels in ℝd, the intention being to capture distinct forms of deviation from equality. This makes them particularly suitable for large-scale genomic screening applications, in which such variety of alternatives can be anticipated. One of these kernels, denoted as L4, introduces weighting by directional densities, hence the evaluation of L4 requires integration on the unit sphere in ℝd. In this note we introduce a methodology for the evaluation of integrals related to L4. It is shown that for a class of directional densities including, but not limited to, the uniform density L4 reduces to Euclidean distance. For other cases, the methodology permits a direct interpretation of L4 in terms of the directional weighting.

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Malivert, Laurent, Isabelle Callebaut, Paola Rivera-Munoz, Alain Fischer, Jean-Paul Mornon, Patrick Revy, and Jean-Pierre de Villartay. "The C-Terminal Domain of Cernunnos/XLF Is Dispensable for DNA Repair In Vivo." Molecular and Cellular Biology 29, no. 5 (December 22, 2008): 1116–22. http://dx.doi.org/10.1128/mcb.01521-08.

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ABSTRACT The core nonhomologous end-joining DNA repair pathway is composed of seven factors: Ku70, Ku80, DNA-PKcs, Artemis, XRCC4 (X4), DNA ligase IV (L4), and Cernunnos/XLF (Cernunnos). Although Cernunnos and X4 are structurally related and participate in the same complex together with L4, they have distinct functions during DNA repair. L4 relies on X4 but not on Cernunnos for its stability, and L4 is required for optimal interaction of Cernunnos with X4. We demonstrate here, using in vitro-generated Cernunnos mutants and a series of functional assays in vivo, that the C-terminal region of Cernunnos is dispensable for its activity during DNA repair.

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Kirchmair, Lukas, Birgit Enna, Gottfried Mitterschiffthaler, Bernhard Moriggl, Manfred Greher, Peter Marhofer, Stephan Kapral, and Ingmar Gassner. "Lumbar Plexus in Children." Anesthesiology 101, no. 2 (August 1, 2004): 445–50. http://dx.doi.org/10.1097/00000542-200408000-00026.

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Background Pediatric regional anesthesia has gained increasing interest over the past decades. The current study was conducted to investigate the lumbar paravertebral region and the lumbar plexus at L3-L4 and L4-L5 by means of sonography to obtain fundamentals for the performance of ultrasound-guided posterior lumbar plexus blocks. Methods Thirty-two children (12 boys, 20 girls) with American Society of Anesthesiologists physical status I or II were enrolled in the current study. The lumbar paravertebral region was visualized at L3-L4 and L4-L5 on two corresponding posterior sonograms (longitudinal, transverse). The lumbar plexus had to be delineated, and skin-plexus distances were measured. In a series of five pediatric patients undergoing inguinal herniotomy, ultrasound-guided posterior lumbar plexus blocks at L4-L5 were performed. Results The children were stratified into three age groups (group 1: > 3 yr and </= 5 yr; group 2: > 5 yr and </= 8 yr; group 3: > 8 yr and </= 12 yr). The lumbar plexus could be delineated at L3-L4 and L4-L5 in 19 of 20 cases in group 1, in 17 of 20 cases in group 2, in 22 of 24 cases at L3-L4 in group 3, and in 16 of 24 cases at L4-L5 in group 3. In all patients, the lumbar plexus was situated within the posterior part of the psoas major muscle. Skin-plexus distances showed statistical significant differences between groups 1 and 3 and between groups 2 and 3. The strongest positive correlation existed between skin-plexus distances and the children's weight. Ultrasound guidance enabled safe und successful posterior approaches to the lumbar plexus, thus resulting in effective anesthesia and analgesia of the inguinal region. Conclusions Sonography of the lumbar plexus in children proved to be feasible. Skin-plexus distances correlated with the children's weight rather than with their age. The sonographic findings were fundamental for the performance of successful ultrasound-guided posterior approaches in a small group of pediatric patients.

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Yao, Xinqiang, Ruoting Ding, Junhao Liu, Siyuan Zhu, Jingshen Zhuang, Zhongyuan Liu, Hui Jiang, Dongbin Qu, Qingan Zhu, and Jianting Chen. "Association between lumbar sacralization and increased degree of vertebral slippage and disc degeneration in patients with L4 spondylolysis." Journal of Neurosurgery: Spine 30, no. 6 (June 2019): 767–71. http://dx.doi.org/10.3171/2018.11.spine18900.

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OBJECTIVEThe aim of this study was to evaluate the effect of lumbar sacralization on the level of vertebral slip and disc degeneration in patients with L4 spondylolysis.METHODSThe authors analyzed data from 102 cases in which patients underwent surgical treatment for L4 spondylolysis and spondylolisthesis at their institution between March 2007 and September 2016. Lumbar sacralization was characterized by the presence of pseudarthrosis and/or bony fusion between the L5 transverse process and sacrum, and the type of lumbosacral transitional vertebra (LSTV) was evaluated with the Castellvi classification. The amount of vertebral slippage was measured using the Taillard technique and Meyerding grade. Degeneration of the L4–5 segment was quantified using the Pfirrmann and Modic classifications. Patients were divided into 2 groups based on the presence or absence of sacralization, and the amount of vertebral slip and degeneration of the L4–5 segment was compared between groups.RESULTSLumbar sacralization was present in 37 (36%) of 102 patients with L4 spondylolysis. The LSTV was type IIa in 10 cases, type IIb in 7, type IIIa in 2, and type IIIb in 18. The levels of vertebral slip and disc degeneration in the group of patients with sacralization were significantly greater than in the group without sacralization. No significant difference was found between the 2 groups with respect to Modic changes.CONCLUSIONSThe increased stability between a sacralized L5 and the sacrum may predispose the L4–5 segment to greater instability and disc degeneration in patients with L4 spondylolysis.

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Journal articles on the topic 'L4'

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