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Korean Journal of Anesthesiology Aug 2022Various techniques for regional anesthesia and analgesia of the thorax are currently being used in clinical practice. A recent international consensus has anatomically...
Various techniques for regional anesthesia and analgesia of the thorax are currently being used in clinical practice. A recent international consensus has anatomically classified paraspinal blocks in the thoracic spinal region into the following four types: paravertebral, retrolaminar, erector spinae plane, and intertransverse process blocks. These blocks have different anatomical targets; thus, the spreading patterns of the injectates differ and can consequently exhibit different neural blockade characteristics. The paravertebral block directly targets the paravertebral space just outside the neuraxial region and has an analgesic efficacy comparable to that of the epidural block; however, there are multiple potential risks associated with this technique. Retrolaminar and erector spinae plane blocks target the erector spinae plane on the vertebral lamina and transverse process, respectively. In anatomical studies, these two blocks showed different injectate spreading patterns to the back muscles and the fascial plane. In cadaveric studies, paravertebral spread was identified, but variable. However, numerous clinical reports have shown paravertebral spread with erector spinae plane blocks. Both techniques have been found to reduce postoperative pain compared to controls; however, the results have been more inconsistent than with the paravertebral block. Finally, the intertransverse process block targets the tissue complex posterior to the superior costotransverse ligament. Anatomical studies have revealed that this block has pathways that are more direct and closer to the paravertebral space than the retrolaminar and erector spinae plane blocks. Cadaveric evaluations have consistently shown promising results; however, further clinical studies using this technique are needed to confirm these anatomical findings.
Topics: Analgesia; Cadaver; Humans; Nerve Block; Pain, Postoperative; Paraspinal Muscles
PubMed: 35368174
DOI: 10.4097/kja.22138 -
Neurosurgery Clinics of North America Apr 2020Traditional surgical techniques for benign intradural and paraspinal nerve sheath tumors often consisted of open posterior approaches. However, these were limited by the... (Review)
Review
Traditional surgical techniques for benign intradural and paraspinal nerve sheath tumors often consisted of open posterior approaches. However, these were limited by the morbidity of open surgery. In addition, iatrogenic instability is often required for total resection of larger or laterally located tumors, thus necessitating the use of additional hardware for spinal fusion. Advances in surgical techniques and technologies have allowed for a plethora of minimally invasive approaches throughout the cervical, thoracic, and lumbar regions. These approaches and their particular applications for the resection of benign peripheral nerve sheath tumors are described, with special attention to modern surgical strategies.
Topics: Humans; Lumbosacral Region; Nerve Sheath Neoplasms; Neurilemmoma; Neurosurgical Procedures; Spinal Cord Neoplasms; Thoracic Vertebrae
PubMed: 32147013
DOI: 10.1016/j.nec.2019.11.002 -
World Neurosurgery May 2023Facet joint orientation (FJO) and facet joint tropism (FJT) are associated with intervertebral disc degeneration and paraspinal muscle atrophy. However, none of the...
BACKGROUND
Facet joint orientation (FJO) and facet joint tropism (FJT) are associated with intervertebral disc degeneration and paraspinal muscle atrophy. However, none of the previous studies has evaluated the association of FJO/FJT with fatty infiltration in the multifidus, erector spinae, and psoas muscles at all lumbar levels. In the present study, we aimed to analyze whether FJO and FJT were associated with fatty infiltration in the paraspinal muscles at any lumbar level.
METHODS
Paraspinal muscles and FJO/FJT were evaluated from L1-L2 to L5-S1 intervertebral disc levels on T2-weighted axial lumbar spine magnetic resonance imaging.
RESULTS
Facet joints were more sagittally and coronally oriented at the upper and lower lumbar levels, respectively. FJT was more obvious at lower lumbar levels. The FJT/FJO ratio was higher at upper lumbar levels. Patients with sagittally oriented facet joints at the L3-L4 and L4-L5 levels had fattier erector spinae and psoas muscles at the L4-L5 level. Patients with increased FJT at upper lumbar levels had fattier erector spinae and multifidus at lower lumbar levels. Patients with increased FJT at the L4-L5 level had less fatty infiltration in the erector spinae and psoas at the L2-L3 and L5-S1 levels, respectively.
CONCLUSIONS
Sagittally oriented facet joints at lower lumbar levels could be associated with fattier erector spinae and psoas muscles at lower lumbar levels. The erector spinae at upper lumbar levels and psoas at lower lumbar levels might have become more active to compensate the FJT-induced instability at lower lumbar levels.
Topics: Humans; Paraspinal Muscles; Zygapophyseal Joint; Lumbosacral Region; Lumbar Vertebrae; Intervertebral Disc Degeneration; Muscular Atrophy; Magnetic Resonance Imaging
PubMed: 36863453
DOI: 10.1016/j.wneu.2023.02.111 -
Journal of Bodywork and Movement... Jul 2019Patients suffering from complex regional pain syndrome (CRPS) endure myofascial-related pain in at least 50% of cases. (Review)
Review
BACKGROUND
Patients suffering from complex regional pain syndrome (CRPS) endure myofascial-related pain in at least 50% of cases.
AIMS
To evaluate the association of upper limb CRPS with myofascial pain in muscles that might influence arm or hand pain, and to evaluate whether the paraspinal skin and subcutaneous layers' tenderness and allodynia are associated with CRPS.
METHODS
A case-control study comprising 20 patients presenting with upper limb CRPS, and 20 healthy controls matched for sex and age, were evaluated in the thoracic paraspinal area and myofascial trigger points (MTrPs) (infraspinatus, rhomboids, subclavius, serratus posterior superior and pectoralis minor) via a skin rolling test.
RESULTS
The prevalence of MTrPs in the affected extremity of the subjects was significantly higher than in the right limb of the controls: 45% exhibited active and latent MTrPs in the infraspinatus muscle (χ = 11.613, p = 0.001); 60% in active and latent MTrPs in the subclavius muscle (χ = 17.143, p < 0.001); and in the pectoralis minor muscle (χ2 = 13.786, p < 0.001). In addition, 55% of the cases exhibited active and latent MTrPs in the serratus posterior superior muscle (χ = 15.172, p < 0.001). Significant differences between the groups in skin texture and pain levels (p = 0.01, p < 0.001, respectively) demonstrated that CRPS patients felt more pain, and their skin and subcutaneous layers were much tighter than in the healthy controls.
CONCLUSION
There is a high prevalence of MTrPs in the shoulder and upper thoracic area muscles in subjects who suffer from CRPS. We recommend adding an MTrPs evaluation to the standardized examination of these patients.
Topics: Adult; Case-Control Studies; Complex Regional Pain Syndromes; Educational Status; Female; Humans; Hyperalgesia; Intermediate Back Muscles; Male; Middle Aged; Myofascial Pain Syndromes; Pain Measurement; Pectoralis Muscles; Severity of Illness Index; Skin; Upper Extremity
PubMed: 31563368
DOI: 10.1016/j.jbmt.2019.02.015 -
BMJ Case Reports Mar 2021Lower lumbar paraspinal muscles constitute a compartment as they are surrounded by distinct fascial and bony boundaries. Lumbar paraspinal compartment syndrome is a rare...
Lower lumbar paraspinal muscles constitute a compartment as they are surrounded by distinct fascial and bony boundaries. Lumbar paraspinal compartment syndrome is a rare entity, often caused by intense exercise, but also can be a postoperative complication. We present a 60-year-old man with low back pain, numbness in the left lower back and radicular pain in the left lower extremity, which started after a surgery that involved prolonged positioning on the left side 7 years before, and persisted to the day of evaluation. There was an immediate transient rise in the creatine kinase after surgery. Electromyography showed a left lower lumbar-sacral plexopathy and a lumbar spine MRI revealed fatty infiltration of the lower lumbar-sacral paraspinal muscles. The emergence of radicular lower limb pain was likely due to the compression of the proximal portion of lumbar-sacral plexus during the acute stage of rhabdomyolysis.
Topics: Compartment Syndromes; Humans; Low Back Pain; Lumbar Vertebrae; Lumbosacral Region; Male; Middle Aged; Paraspinal Muscles; Rhabdomyolysis
PubMed: 33782060
DOI: 10.1136/bcr-2020-236040 -
World Neurosurgery May 2021Giant paraspinal thoracic schwannomas (GPTSs) are benign, slow-growing, encapsulated lesions. They can be intracanalicular, span more than 2 vertebral bodies, and/or...
BACKGROUND
Giant paraspinal thoracic schwannomas (GPTSs) are benign, slow-growing, encapsulated lesions. They can be intracanalicular, span more than 2 vertebral bodies, and/or have a foraminal component with extraspinal extension >2.5 cm. They pose surgical challenges because of the often unfamiliar complex regional anatomy. We report the largest series of GPTSs and discuss regional surgical strategies for tumors in the thoracic spine.
METHODS
We conducted a retrospective review of GPTSs operated at a national spinal referral center between December 2008 and October 2019. Inclusion criteria included World Health Organization grade 1 GPTS. Patient demographics, clinical features, radiology, and histopathology were assessed.
RESULTS
Seventeen patients (12 females, 5 males) had a mean age of 48.1 years (range 21-65 years). Five GPTS (29%) were located at T1-T3, 6 (35%) at T4-6, and 6 (35%) below T6. The mean maximum diameter was 58.5 ± 19.1 mm (range 30-91 mm). Mean volume was 90.9 cm (range 19.1-350.6 cm). Twelve (70%) had a fluorodeoxyglucose positron emission tomography scan showing low (25%) or moderate to high (75%) uptake. Six patients (35%) had preoperative computed tomography-guided biopsy. Surgical approaches included 1) manubriotomy and variations (4/17); 2) high lateral thoracotomy (4/17); 3) posterior parascapular (1/17); 4) standard lateral thoracotomy (3/16); 5) posterior/posterolateral (2/17); and 6) combined posterior and thoracotomy (3/17). All patients had gross total resection and were grade 1 cellular schwannomas. No recurrence at final follow-up (mean 36.1 months, range 8-130 months).
CONCLUSIONS
A number of approaches are available to resect GPST in specific locations in the thoracic spine. Total resection is achievable despite complex regional anatomy, location, and tumor extension but often requires anterior or combined approaches.
Topics: Adult; Aged; Female; Humans; Image-Guided Biopsy; Male; Middle Aged; Neoplasm Recurrence, Local; Neurilemmoma; Neurosurgical Procedures; Positron-Emission Tomography; Postoperative Complications; Retrospective Studies; Spinal Neoplasms; Sternotomy; Thoracic Vertebrae; Thoracotomy; Tomography, X-Ray Computed; Treatment Outcome; Young Adult
PubMed: 33516861
DOI: 10.1016/j.wneu.2020.11.174 -
Cureus Oct 2022About a quarter of the world's population is infected with tuberculosis (TB). It is one of the leading causes of death worldwide. However, the prevalence of TB in the...
About a quarter of the world's population is infected with tuberculosis (TB). It is one of the leading causes of death worldwide. However, the prevalence of TB in the United States is rare. Pulmonary TB is the commonest form of TB. Most patients with TB present with pulmonary symptoms. Extrapulmonary TB usually presents with symptoms related to the organ system involved and can present with very unusual symptoms. TB presenting with dysphagia is uncommon, and spinal TB presenting with dysphagia is very unusual. A 57-year-old woman presented to the emergency department with a four-month history of dysphagia and chest pain. She was undergoing an outpatient workup of her symptoms that included esophagogastroduodenoscopy, gastric emptying study, and computed tomography (CT) scan of the chest, which showed incidental findings of a focus in the thoracic spine. It was followed by a bone scan, and the results were concerning for malignancy. She was awaiting an oncology appointment when she presented to us. A basic workup after her presentation that includes complete blood count, comprehensive metabolic panel, troponin, chest x-ray, and electrocardiogram was unrevealing. Magnetic resonance imaging (MRI) of the thoracic spine showed findings suggestive of tuberculous spondylitis, tuberculous paraspinal, and prevertebral abscesses. Chest CT was repeated, which showed mass effect and erosion on the posterior esophageal wall with anterior displacement of the esophagus. Tissue biopsy revealed acid-fast bacilli (AFB) on AFB stain, and the culture grew . She was successfully treated with the antitubercular regimen of rifampin, isoniazid, ethambutol, and pyrazinamide. TB can present with a myriad of symptoms, and although rare, it can present with symptoms like dysphagia. In patients with a history of travel to or immigration from an endemic region, previous infection, and immunosuppression, TB should be considered as one of the differential diagnoses even for unusual symptoms like dysphagia.
PubMed: 36397918
DOI: 10.7759/cureus.30174 -
European Spine Journal : Official... May 2024To explore degeneration and fatty infiltration (FI) of lumbar paraspinal muscles in patients with dynamic sagittal imbalance (DSI) and the relationship between lumbar...
PURPOSE
To explore degeneration and fatty infiltration (FI) of lumbar paraspinal muscles in patients with dynamic sagittal imbalance (DSI) and the relationship between lumbar paraspinal muscles degeneration, fatty infiltration and severity of the disease.
METHODS
We recruited 41 DSI patients and selected 22 lumbar spinal stenosis (LSS) patients without osphyalgia as controls. All patients received magnetic resonance imaging (MRI) scan and DSI patients also received pre-walk and post-walk X-rays. DSI patients were divided into 2 subgroups according to their symptom improvement after conservative treatment. We calculated rmCSA and FI of the lumbar paraspinal muscles. The rmCSA and FI between DSI and control and between DSI subgroups were compared by t test. The regression analysis was used to explore the risk factors influencing disease severity. Receiver operating characteristic (ROC) curves and area under curves (AUCs) were used to evaluate the severity of the disease.
RESULTS
In comparison of rmCSA and FI between DSI and control, there are significant differences of most muscles. In comparison of rmCSA between two subgroups, there are significant differences of most muscles, while in comparison of FI, only muscles in L4 segment have significant different. In logistic regression analysis, total rmCSA and total FI are risk factors influencing disease severity. ROC curves shows that total rmCSA and total FI both achieve an AUC greater than 0.7.
CONCLUSION
Compared with control, DSI patients have degeneration and fatty infiltration of the lumbar paraspinal muscles. The degeneration and fatty infiltration are risk factors influencing disease severity. The total rmCSA and total FI can be used as an indicator to determine whether a patient has severe DSI.
Topics: Humans; Paraspinal Muscles; Male; Female; Middle Aged; Magnetic Resonance Imaging; Aged; Lumbar Vertebrae; Spinal Stenosis; Adipose Tissue; Adult; Lumbosacral Region
PubMed: 38043127
DOI: 10.1007/s00586-023-08033-4 -
BMC Musculoskeletal Disorders Aug 2022The quality of the paraspinal muscles has been recommended as a surrogate marker for the evaluation of the severity of the lumbar degenerative diseases (LDD). The...
BACKGROUND
The quality of the paraspinal muscles has been recommended as a surrogate marker for the evaluation of the severity of the lumbar degenerative diseases (LDD). The purpose of this study is to determine the age- and sex-dependent differences in the morphology and composition of the paraspinal muscles between LDD and asymptomatic subjects.
METHODS
We analyzed data from 370 patients and 327 asymptomatic volunteers aged between 18-85 years. The measurement of the cross-sectional area (CSA) of the erector spinae, multifidus, and psoas at the L4/5-disc level was performed by the magnetic resonance imaging (MRI). The fatty infiltration ratio (FI %) of the multifidus and erector spinae was calculated.
RESULTS
FI % of the lumbar paraspinal muscles were significantly and positively correlated with the severity of LDD instead of the CSA. Males had greater CSA than females, and females showed higher FI % than males in the paraspinal muscles. With the increase of age, the CSA of the lumbar paraspinal muscles gradually decreased, and the psoas showed the most significant decreasing trend. However, the FI % gradually increased in both LDD and asymptomatic groups with aging.
CONCLUSION
Age- and sex-dependent differences were found in the morphology and composition of the paraspinal muscles between subjects with and without LDD. Further long-term follow up investigations and basic studies will continue to confirm the natural history of the paraspinal muscles with aging and their association with LDD.
Topics: Adipose Tissue; Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Low Back Pain; Lumbar Vertebrae; Lumbosacral Region; Magnetic Resonance Imaging; Male; Middle Aged; Paraspinal Muscles; Young Adult
PubMed: 35915426
DOI: 10.1186/s12891-022-05692-0 -
Journal of Sport Rehabilitation Aug 2022Injuries involving the lumbopelvic region (ie, lumbar spine, pelvis, hip) are common across the lifespan and include pathologies such as low back pain, femoroacetabular...
Injuries involving the lumbopelvic region (ie, lumbar spine, pelvis, hip) are common across the lifespan and include pathologies such as low back pain, femoroacetabular impingement syndrome, labrum tear, and osteoarthritis. Joint injury is known to result in an arthrogenic muscle response which contributes to muscle weakness and altered movement patterns. The purpose of this manuscript is to summarize the arthrogenic muscle response that occurs across lumbopelvic region pathologies, identify methods to quantify muscle function, and propose suggestions for future research. While each lumbopelvic region pathology is unique, there are a few common impairments and a relative consistent arthrogenic muscle response that occurs across the region. Hip muscle weakness and hip joint range of motion limitations occur with both lumbar spine and hip pathologies, and individuals with low back pain are known to demonstrate inhibition of the transversus abdominis and multifidus. Assessment of muscle inhibition is often limited to research laboratory settings, but dynamometers, ultrasound imaging, and electromyography offer clinical capacity to quantify muscle function and inform treatment pathways. Future studies should systematically determine the arthrogenic muscle response across multiple muscle groups and the timeline for changes in muscle function and determine whether disinhibitory modalities improve functional outcomes beyond traditional treatment approaches.
Topics: Electromyography; Humans; Low Back Pain; Lumbosacral Region; Muscle Weakness; Paraspinal Muscles
PubMed: 35894966
DOI: 10.1123/jsr.2021-0258