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Neurosurgery Feb 2021Neoplasms of the peripheral nervous system represent a heterogenous group with a wide spectrum of morphological features and biological potential. They range from benign... (Review)
Review
Neoplasms of the peripheral nervous system represent a heterogenous group with a wide spectrum of morphological features and biological potential. They range from benign and curable by complete excision (schwannoma and soft tissue perineurioma) to benign but potentially aggressive at the local level (plexiform neurofibroma) to the highly malignant (malignant peripheral nerve sheath tumors [MPNST]). In this review, we discuss the diagnostic and pathologic features of common peripheral nerve sheath tumors, particularly those that may be encountered in the intracranial compartment or in the spine and paraspinal region. The discussion will cover schwannoma, neurofibroma, atypical neurofibromatous neoplasms of uncertain biological potential, intraneural and soft tissue perineurioma, hybrid nerve sheath tumors, MPNST, and the recently renamed enigmatic tumor, malignant melanotic nerve sheath tumor, formerly referred to as melanotic schwannoma. We also discuss the diagnostic relevance of these neoplasms to specific genetic and familial syndromes of nerve, including neurofibromatosis 1, neurofibromatosis 2, and schwannomatosis. In addition, we discuss updates in our understanding of the molecular alterations that represent key drivers of these neoplasms, including neurofibromatosis type 1 and type 2, SMARCB1, LZTR1, and PRKAR1A loss, as well as the acquisition of CDKN2A/B mutations and alterations in the polycomb repressor complex members (SUZ12 and EED) in the malignant progression to MPNST. In summary, this review covers practical aspects of pathologic diagnosis with updates relevant to neurosurgical practice.
Topics: Animals; Humans; Nerve Sheath Neoplasms; Neurilemmoma; Neurofibroma; Neurofibromatoses; Peripheral Nerves; Peripheral Nervous System Neoplasms; Skin Neoplasms; Transcription Factors
PubMed: 33588442
DOI: 10.1093/neuros/nyab021 -
The British Journal of Radiology Mar 2020Proton beam therapy is a highly conformal form of radiation therapy, which currently represents an important therapeutic component in multidisciplinary management in... (Review)
Review
Proton beam therapy is a highly conformal form of radiation therapy, which currently represents an important therapeutic component in multidisciplinary management in paediatric oncology. The precise adjustability of protons results in a reduction of radiation-related long-term side-effects and secondary malignancy induction, which is of particular importance for the quality of life. Proton irradiation has been shown to offer significant advantages over conventional photon-based radiotherapy, although the biological effectiveness of both irradiation modalities is comparable. This review evaluates current data from clinical and dosimetric studies on the treatment of tumours of the central nervous system, soft tissue and bone sarcomas of the head and neck region, paraspinal or pelvic region, and retinoblastoma. To date, the clinical results of irradiating childhood tumours with high-precision proton therapy are promising both with regard to tumour cure and the reduction of adverse events. Modern proton therapy techniques such as pencil beam scanning and intensity modulation are increasingly established modern facilities. However, further investigations with larger patient cohorts and longer follow-up periods are required, in order to be able to have clear evidence on clinical benefits.
Topics: Bone Neoplasms; Central Nervous System Neoplasms; Child; Head and Neck Neoplasms; Humans; Neoplasms; Proton Therapy; Radiotherapy Dosage; Radiotherapy, Intensity-Modulated; Retinal Neoplasms; Retinoblastoma; Sarcoma; Soft Tissue Neoplasms; Spinal Neoplasms
PubMed: 31529979
DOI: 10.1259/bjr.20190601 -
Brazilian Journal of Physical Therapy 2019One proposed mechanism of chronic low back pain might be paraspinal muscle impairment. Commonly, this impairment is treated with stabilization exercises. However, the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
One proposed mechanism of chronic low back pain might be paraspinal muscle impairment. Commonly, this impairment is treated with stabilization exercises. However, the effect size of stabilization exercises has been previously reported to be small.
DESIGN
Randomized controlled trial.
OBJECTIVE
To investigate the clinical benefit of using neuromuscular electrical stimulation as a supplement to stabilization exercises in patients with chronic low back pain.
METHODS
Thirty participants with chronic low back pain were randomized into a stabilization exercise only group (n=15) or a stabilization exercise plus neuromuscular electrical stimulation group (n=15). The stabilization exercises included abdominal, side support, and quadruped exercises. The neuromuscular electrical stimulation was applied to the lumbar paraspinal muscles for 20min each session. Both groups received their respective interventions twice a week for 6 weeks. Participant eligibility for inclusion was age between 18 and 60 years, body mass index ≤34, chronic low back pain ≥3 months, Numeric Pain Rating Scale ≥3, Modified Oswestry Disability Questionnaire score ≥20 and ability to understand English. Outcome measurements were self-reported neuromuscular electrical stimulation tolerability scale, Modified Oswestry Disability Questionnaire, Numeric Pain Rating Scale, Fear-Avoidance Beliefs Questionnaire and paraspinal muscle strength.
RESULTS
The neuromuscular electrical stimulation was reported to be tolerable. There were no significant between-group differences on any of the outcome measures (p>0.05).
CONCLUSIONS
The application of neuromuscular electrical stimulation on the paraspinal muscles was reported to be tolerable. Supplementing stabilization exercises with neuromuscular electrical stimulation did not offer any additional clinical benefit for the chronic low back pain patients.
Topics: Child, Preschool; Electric Stimulation; Exercise Therapy; Humans; Infant; Low Back Pain; Lumbosacral Region; Muscle Strength
PubMed: 30482602
DOI: 10.1016/j.bjpt.2018.10.003 -
International Journal of Environmental... Feb 2022The present study examined the posterior chain muscle excitation in different deadlift variations. Ten competitive bodybuilders (training seniority of 10.6 ± 1.8 years)...
The present study examined the posterior chain muscle excitation in different deadlift variations. Ten competitive bodybuilders (training seniority of 10.6 ± 1.8 years) performed the Romanian (RD), Romanian standing on a step (step-RD), and stiff-leg deadlift (SD) with an 80% 1-RM. The excitation of the gluteus maximus, gluteus medius, biceps femoris, semitendinosus, erector spinae longissimus, and iliocostalis was assessed during both the ascending and descending phases. During the ascending phase, the RMS of the gluteus maximus was greater in the step-RD than in the RD (effect size (ES): 1.70, 0.55/2.84) and SD (ES: 1.18, 0.11/2.24). Moreover, a greater RMS was found in the SD than in the RD (ES: 0.99, 0.04/1.95). The RMS of the semitendinosus was greater in the step-RD than in the RD (ES: 0.82, 0.20/1.44) and SD (ES: 3.13, 1.67/4.59). Moreover, a greater RMS was found in the RD than in the SD (ES: 1.38, 0.29/2.48). The RMS of the longissimus was greater in the step-RD than in the RD (ES: 2.12, 0.89/3.34) and SD (ES: 3.28, 1.78/4.78). The descending phase had fewer differences between the exercises. No further differences between the exercises were found. The step-RD increased the overall excitation of the posterior chain muscles, possibly because of the greater range of movement and posterior muscle elongation during the anterior flexion. Moreover, the RD appeared to target the semitendinosus more than the SD, while the latter excited the gluteus maximus more.
Topics: Electromyography; Humans; Leg; Muscle, Skeletal; Paraspinal Muscles; Resistance Training; Romania
PubMed: 35162922
DOI: 10.3390/ijerph19031903 -
The Journal of Manual & Manipulative... Jun 2022Dry needling treatment focuses on restoring normal muscle function in patients with musculoskeletal pain; however, little research has investigated this assertion. Shear... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Dry needling treatment focuses on restoring normal muscle function in patients with musculoskeletal pain; however, little research has investigated this assertion. Shear wave elastography (SWE) allows quantification of individual muscle function by estimating both resting and contracted muscle stiffness.
OBJECTIVE
To compare the effects of dry needling to sham dry needling on lumbar muscle stiffness in individuals with low back pain (LBP) using SWE.
METHODS
Sixty participants with LBP were randomly allocated to receive one session of dry needling or sham dry needling treatment to the lumbar multifidus and erector spinae muscles on the most painful side and spinal level. Stiffness (shear modulus) of the lumbar multifidus and erector spinae muscles was assessed using SWE at rest and during submaximal contraction before treatment, immediately after treatment, and 1 week later. Treatment effects were estimated using linear mixed models.
RESULTS
After 1 week, resting erector spinae muscle stiffness was lower in individuals who received dry needling than those that received sham dry needling. All other between-groups differences in muscle stiffness were similar, but non-significant.
CONCLUSION
Dry needling appears to reduce resting erector spinae muscle following treatment of patients with LBP. Therefore, providers should consider the use of dry needling when patients exhibit aberrant stiffness of the lumbar muscles.
Topics: Dry Needling; Elasticity Imaging Techniques; Humans; Low Back Pain; Lumbosacral Region; Paraspinal Muscles
PubMed: 34525901
DOI: 10.1080/10669817.2021.1977069 -
Insights Into Imaging Jul 2023The paraspinal region encompasses all tissues around the spine. The regional anatomy is complex and includes the paraspinal muscles, spinal nerves, sympathetic chains,... (Review)
Review
The paraspinal region encompasses all tissues around the spine. The regional anatomy is complex and includes the paraspinal muscles, spinal nerves, sympathetic chains, Batson's venous plexus and a rich arterial network. A wide variety of pathologies can occur in the paraspinal region, originating either from paraspinal soft tissues or the vertebral column. The most common paraspinal benign neoplasms include lipomas, fibroblastic tumours and benign peripheral nerve sheath tumours. Tumour-like masses such as haematomas, extramedullary haematopoiesis or abscesses should be considered in patients with suggestive medical histories. Malignant neoplasms are less frequent than benign processes and include liposarcomas and undifferentiated sarcomas. Secondary and primary spinal tumours may present as midline expansile soft tissue masses invading the adjacent paraspinal region. Knowledge of the anatomy of the paraspinal region is of major importance since it allows understanding of the complex locoregional tumour spread that can occur via many adipose corridors, haematogenous pathways and direct contact. Paraspinal tumours can extend into other anatomical regions, such as the retroperitoneum, pleura, posterior mediastinum, intercostal space or extradural neural axis compartment. Imaging plays a crucial role in formulating a hypothesis regarding the aetiology of the mass and tumour staging, which informs preoperative planning. Understanding the complex relationship between the different elements and the imaging features of common paraspinal masses is fundamental to achieving a correct diagnosis and adequate patient management. This review gives an overview of the anatomy of the paraspinal region and describes imaging features of the main tumours and tumour-like lesions that occur in the region.
PubMed: 37466751
DOI: 10.1186/s13244-023-01462-1 -
Journal of Rehabilitation Medicine Apr 2021To evaluate the effects of a rehabilitation programme for lumbopelvic pain after childbirth. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To evaluate the effects of a rehabilitation programme for lumbopelvic pain after childbirth.
METHODS
Women with lumbopelvic pain 3 months postpartum were included in a randomized controlled trial. Patients in the intervention group (n = 48) received pelvic floor muscle training combined with neuromuscular electrical stimulation of the paraspinal muscles for 12 weeks, while patients in the control group (n = 48) received neuromuscular electrical stimulation for 12 weeks. Outcomes were measured with the Triple Numerical Pain Rating Scale (NPRS), Modified Oswestry Disability Questionnaire (MODQ) and Short-Form Health Survey-36 (SF-36).
RESULTS
The NPRS score was significantly better in the intervention group at 12 weeks compared with the control group (p = 0.000). The MODQ score was significantly better at 6 and 12 weeks compared with the control group (p = 0.009 and p = 0.015, respectively). The mean value of the Physical Components Summary of the SF-36, was significantly better in the intervention group at 6 weeks (p = 0.000) and 12 weeks (p = 0.000) compared with the control group, but there was no significant improvement in Mental Components Summary of the SF-36.
CONCLUSION
A postpartum programme for women with lumbopelvic pain is feasible and improves the physical domain of quality of life.
Topics: Adult; Exercise Therapy; Female; Humans; Lumbosacral Region; Pain; Pelvic Floor; Postpartum Period; Pregnancy; Quality of Life
PubMed: 33723616
DOI: 10.2340/16501977-2812 -
International Journal of Environmental... Jan 2023Postoperative pain is common following spine surgery, particularly complex procedures. The main anesthetic efforts are focused on applying multimodal analgesia... (Review)
Review
Postoperative pain is common following spine surgery, particularly complex procedures. The main anesthetic efforts are focused on applying multimodal analgesia beforehand, and regional anesthesia is a critical component of it. The purpose of this study is to examine the existing techniques for regional anesthesia in cervical spine surgery and to determine their effect and safety on pain reduction and postoperative patient's recovery. The electronic databases were searched for all literature pertaining to cervical nerve block procedures. The following peripheral, cervical nerve blocks were selected and described: paravertebral block, cervical plexus clock, paraspinal interfascial plane blocks such as multifidus cervicis, retrolaminar, inter-semispinal and interfacial, as well as erector spinae plane block and stellate ganglion block. Clinicians should choose more superficial techniques in the cervical region, as they have been shown to be comparably effective and less hazardous compared to paravertebral blocks.
Topics: Female; Humans; Cervix Uteri; Nerve Block; Pain Management; Anesthesia, Conduction; Ultrasonography, Interventional
PubMed: 36767465
DOI: 10.3390/ijerph20032098 -
Medicine Dec 2022Interpretation of the morphology and characteristics of soft tissues, such as paravertebral muscles and fat, has always been a "relative blind spot" in the spine. The... (Review)
Review
Interpretation of the morphology and characteristics of soft tissues, such as paravertebral muscles and fat, has always been a "relative blind spot" in the spine. The imaging features of the non-bony structures of the spine have been studied and reinterpreted, and changes in the non-bony structure are associated with spinal disease. Soft tissue parameters such as, the "paraspinal muscle cross-sectional area," "subcutaneous fat thickness," and the "paraspinal muscle fat infiltration rate" on computed tomography, magnetic resonance imaging and other imaging techniques are reproducible in the diagnosis, treatment and prognosis of spinal disorders and have the potential for clinical application. In addition, focus on the association between sarcopenia and spinal epidural lipomatosis with spinal disorders is increasing. Currently, there is no summary of studies on fat and muscle in the spinal region. Given this, within the context of recent research trends, this article provides a synthesis of research on adipose and muscle tissue in the spine, discusses advances in the study of the imaging manifestations of these structures in spinal disorders, and expands the perspectives.
Topics: Humans; Lumbar Vertebrae; Spinal Diseases; Sarcopenia; Magnetic Resonance Imaging; Muscles; Adipose Tissue; Paraspinal Muscles
PubMed: 36626484
DOI: 10.1097/MD.0000000000032051