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Muscle & Nerve Feb 2024Limited data exist regarding variation of electrodiagnostic (EDX) findings in amyotrophic lateral sclerosis (ALS) patients with different onset regions and specificity...
INTRODUCTION/AIMS
Limited data exist regarding variation of electrodiagnostic (EDX) findings in amyotrophic lateral sclerosis (ALS) patients with different onset regions and specificity of thoracic paraspinal muscle (TPSP) examination for confirming a diagnosis of ALS. We aimed to demonstrate the variation of EDX features and characterize the utility of TPSP muscle examination in the electrodiagnosis of ALS.
METHODS
This is a retrospective study of a large cohort of ALS patients who had a comprehensive EDX evaluation.
RESULTS
The study included 448 patients; all fulfilled the Gold Coast criteria for ALS. The average age at the time of EDX study was 64 years, and 41.1% were women. The onset region was identified as follows: bulbar (N = 149), cervical (N = 127), lumbosacral (N = 162), and other (N = 10). In contrast to limb onset, bulbar-onset patients more frequently demonstrated a pattern of normal or near normal needle electromyography (EMG) (p < .0001) and less frequently had abnormalities on EMG of TPSP (p = .002). Clinical or EDX diagnosis of sensory polyneuropathy was present in 12.6% patients, more frequently in the lumbosacral onset subgroup (p < .03). EMG showed active denervation in 9.6% and chronic denervation in 59% of craniobulbar muscles examined, without observed difference among different onset regions. TPSP showed higher frequencies of active and chronic denervation in ALS than a group of patients with non-ALS neuromuscular disorders.
DISCUSSION
EDX features may differ among ALS patients of different onset regions. TPSP EMG is highly useful in differentiating ALS from non-ALS neuromuscular disorders while the yield of craniobulbar muscles, especially for active denervation, is low.
Topics: Humans; Female; Male; Amyotrophic Lateral Sclerosis; Retrospective Studies; Paraspinal Muscles; Electromyography; Electrodiagnosis
PubMed: 38038225
DOI: 10.1002/mus.28012 -
European Spine Journal : Official... Nov 2022Fat infiltration (FI) of the paraspinal muscles (PSMs) measured using MRI is an aspect of muscle quality and is considered to be worse in chronic low back pain (cLBP)...
PURPOSE
Fat infiltration (FI) of the paraspinal muscles (PSMs) measured using MRI is an aspect of muscle quality and is considered to be worse in chronic low back pain (cLBP) patients. However, there is not a clear association between paraspinal muscle FI and cLBP, leaving the clinical importance of paraspinal muscle composition unestablished. The spatial distribution of FI in the PSMs may inform mechanistic understanding of non-specific cLBP as it relates to degenerative intervertebral disc (IVD) pathology. We hypothesized that paraspinal muscle fat-mapping would reveal distinct FI distribution patterns in relation to cLBP symptoms and proximity to symptomatic IVD degeneration.
METHODS
From advanced-sequence water-fat MRI of 40 axial cLBP patients and 21 controls, we examined the spatial distribution of paraspinal muscle FI in relation to the center of rotation at the L4L5 disc. Using statistical parametric mapping, we compared FI patterns for multifidus (MF), erector spinae (ES), and psoas between patients and controls, and to the presence and severity of adjacent degenerative IVD pathology.
RESULTS
The spatial distribution of PSMs FI differs between PSMs and according to symptoms and the adjacent degenerative IVD pathology. Furthermore, the region of MF closest to the disc center of rotation appears most susceptible to FI in the presence of symptomatic IVD degeneration.
CONCLUSION
Our study identified spatial distribution patterns of FI in the PSMs as a potential diagnostic biomarker that may also provide granular mechanistic insights into spine biomechanics related to cLBP, as well as advancing the use of prior summary measures limited to overall muscle FI.
Topics: Humans; Paraspinal Muscles; Low Back Pain; Lumbar Vertebrae; Magnetic Resonance Imaging
PubMed: 35776179
DOI: 10.1007/s00586-022-07296-7 -
Journal of Surgical Case Reports Oct 2023A 4-year-old male child presented to us with a paraspinal pseudo-tumor over the mid-back region with pain being his only symptom. On initial ultrasonography, it was...
A 4-year-old male child presented to us with a paraspinal pseudo-tumor over the mid-back region with pain being his only symptom. On initial ultrasonography, it was presumed to be a nerve sheath tumor, but on an excision biopsy and histopathology, it proved to be a subcutaneous cysticercosis. Furthermore, an MRI of the brain showed a ring enhancing lesion with vasogenic edema, which confirmed the diagnosis of a neurologically symptomless neurocysticercosis. We treated the patient with albendazole and a short course of dexamethasone. There was complete resolution of the painful subcutaneous swelling, and the patient remained neurologically symptomless at all subsequent follow-ups. Resolution of the brain lesions was seen in the 6-month MRI follow-up. Although rare, orthopedic surgeons should consider the possibility of parasitic infections when dealing with small near-asymptomatic soft tissue paraspinal swellings of uncertain etiology. A thorough investigation in such cases can be lifesaving.
PubMed: 37873045
DOI: 10.1093/jscr/rjad544 -
BMJ Case Reports Mar 2012Approximately 4%-8% of patients with pulmonary tuberculosis develop clinically significant genitourinary infection. In the case being reported, a 30-year-old female,...
Approximately 4%-8% of patients with pulmonary tuberculosis develop clinically significant genitourinary infection. In the case being reported, a 30-year-old female, admitted with right-sided back swelling, local pain and low-grade fever. The swelling gradually increased in size over a period of 6 months and had burst spontaneously forming a pus discharging with associated localised pain and fever bringing the patient to the hospital. X-ray lumbar spine, chest and kidney ureter bladder showed no abnormalities. Ultrasound findings were suggestive of pyonephrosis with a posterior paraspinal abscess with a sinus tract within the posterior paraspinal region. CT findings were more conclusive in suggesting the sinus tract origin. Finding of tuberculous kidney and upper ureteric stricture with sinus tract opening in the posterior paraspinal region was made on CT. Right nephrectomy was done. Histopathologically proved it to be tuberculous kidney.
Topics: Adult; Contrast Media; Diagnosis, Differential; Diagnostic Imaging; Epidural Abscess; Female; Humans; Nephrectomy; Tuberculosis, Renal
PubMed: 22605826
DOI: 10.1136/bcr.12.2011.5445 -
Skeletal Radiology Dec 2015Aggregomas are rare localized masses of monoclonal nonamyloid immunoglobulin light-chain deposits. To date, there have been only a few reports of isolated aggregomas,...
Aggregomas are rare localized masses of monoclonal nonamyloid immunoglobulin light-chain deposits. To date, there have been only a few reports of isolated aggregomas, with the majority detailing renal, lymph node and brain deposition. We present a rare case of paraspinal aggregoma in a 67-year-old female who presented with a complaint of cough and chest pain. Imaging demonstrated a left-sided paravertebral mass extending from T7-T10. Pathological analysis showed lamellar deposition of extracellular eosinophilic material with an associated lymphoplasmacytic nonamyloid infiltrate. To our knowledge, this is the first report of a paraspinal aggregoma. While exceedingly rare, this tumor can be included in the radiologic differential diagnosis of paravertebral soft tissue tumors in adults. The observation of our case adds to the limited understanding of the etiology, pathogenesis, natural history, and treatment of nonamyloid light-chain depositions.
Topics: Aged; Female; Humans; Immunoglobulin Light Chains; Paraproteinemias; Spinal Neoplasms; Thoracic Neoplasms; Treatment Outcome
PubMed: 26253133
DOI: 10.1007/s00256-015-2223-4 -
The Journal of Orthopaedic and Sports... Oct 2007Interest in rehabilitative ultrasound imaging (RUSI) of the posterior paraspinal muscles is growing, along with the body of literature to support integration of this... (Review)
Review
Interest in rehabilitative ultrasound imaging (RUSI) of the posterior paraspinal muscles is growing, along with the body of literature to support integration of this technique into routine physical therapy practice. This clinical commentary reviews how RUSI can be used as an evaluative and treatment tool and proposes guidelines for its use for the posterior muscles of the lumbar and cervical regions. Both quantitative and qualitative applications are described, as well as measurement reliability and validity. Measurement of morphological characteristics of the muscles (morphometry) in healthy populations and people with spinal pathology are described. Preliminary normal reference data exist for measurements of cross-sectional area (CSA), linear dimensions (muscle depth/thickness and width), and shape ratios. Compared to individuals without low back pain, changes in muscles' size at rest and during the contracted state have been observed using RUSI in people with spinal pathology. Visual observation of the image during contraction indicates that RUSI may be a valuable biofeedback tool. Further investigation of many of these observations is required using controlled studies to provide conclusive evidence that RUSI enhances clinical practice.
Topics: Adolescent; Adult; Aged; Female; Guidelines as Topic; Humans; Low Back Pain; Lumbosacral Region; Male; Middle Aged; Muscle, Skeletal; Neck; Ultrasonography; United States
PubMed: 17970405
DOI: 10.2519/jospt.2007.2599 -
Regional Anesthesia and Pain Medicine Jan 2021
Topics: Humans; Levobupivacaine; Nerve Block; Paraspinal Muscles
PubMed: 32273311
DOI: 10.1136/rapm-2020-101482 -
BMJ Case Reports Feb 2019Although cocaine induced myopathy and myotoxicity are described in the literature, we report a rare case of cocaine induced paraspinal myositis presenting with acute...
Although cocaine induced myopathy and myotoxicity are described in the literature, we report a rare case of cocaine induced paraspinal myositis presenting with acute sciatic symptoms. A 35-year-old man presented with acute left-sided sciatica and was discharged from the emergency department (ED). He subsequently attended ED the following day in severe pain and bilateral sciatic symptoms, but denied symptoms of neurogenic bowel/bladder disturbance. Clinical examination was limited by severe pain: focal midline lumbar tenderness was elicited on palpation, per rectal and limb examinations were within normal limits with no significant neurological deficit. He was admitted for observation and pain management. His blood tests revealed a leucocyte count of 21.5×10/L, C reactive protein of 89 mg/L and deranged renal function with creatinine of 293 μmol/L. An urgent lumbar spine MRI was arranged to rule out a discitis or epidural abscess. Lumbar MRI did not demonstrate any features of discitis but non-specific appearances of paraspinal inflammation raised the suspicion of a paraspinal myositis. Creatinekinase (CK) was found to be 66329 IU/L and a detailed history revealed he was a cocaine user. Paraspinal muscle biopsy confirmed histological features compatible with myositis. Other serological tests were negative, including anti-GBM, ANCA, ANA, Rheumatoid factor, Hep B, Hep C, myositis specific ENA, , , , , EBV and CMV. There was good clinical response to treatment with prednisolone 20 mg OD with an improvement in renal function, CK levels and CRP. He had resumed normal activities and return to work at 6-week follow-up. A detailed social history including substance misuse is important in patients presenting to the ED-especially in cases of severe musculoskeletal pain with no obvious localising features. Drug induced myotoxicity, although rare, can result in symptomatic patients with severe renal failure.
Topics: Adult; Cocaine Smoking; Cocaine-Related Disorders; Diagnosis, Differential; Humans; Lumbosacral Region; Male; Myositis; Pain, Intractable; Prednisolone; Sciatica; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 30796068
DOI: 10.1136/bcr-2018-224480 -
Expert Opinion on Drug Metabolism &... Sep 2022
Topics: Anesthetics, Local; Humans; Nerve Block; Pain, Postoperative; Paraspinal Muscles
PubMed: 36084290
DOI: 10.1080/17425255.2022.2122811 -
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