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Neurosurgical Focus Jun 2024Children with cerebral palsy (CP) often experience medically refractory hypertonia, for which there are surgical therapies including neuromodulation and rhizotomy....
OBJECTIVE
Children with cerebral palsy (CP) often experience medically refractory hypertonia, for which there are surgical therapies including neuromodulation and rhizotomy. Traditional surgical treatment for medically refractory mixed hypertonia or dystonia includes intrathecal baclofen pumps and selective dorsal rhizotomy. A nonselective lumbosacral ventral-dorsal rhizotomy (VDR; ventral and dorsal roots lesioned by 80%-90%) has the potential to address the limitations of traditional surgical options. The authors highlighted the institutional safety and efficacy of nonselective lumbosacral VDR for palliative tone management in nonambulatory patients with more severe CP.
METHODS
The authors performed a retrospective analysis of patients who had undergone lumbosacral VDR between 2022 and 2023. Demographic factors, clinical variables, and operative characteristics were collected. The primary outcomes of interest included tone control and quality of life improvement. Secondary outcome measures included, as a measure of safety, perioperative events such as paresthesias. Postoperative complications were also noted.
RESULTS
Fourteen patients (7 female) were included in the study. All patients had undergone a T12-L2 osteoplastic laminoplasty and bilateral L1-S1 VDR. Nine patients had quadriplegic mixed hypertonia, 4 had quadriplegic spasticity, and 1 had generalized secondary dystonia. Following VDR, there was a significant decrease in both lower-extremity modified Ashworth Scale (mAS) scores (mean difference [MD] -2.77 ± 1.0, p < 0.001) and upper-extremity mAS scores (MD -0.71 ± 0.76, p = 0.02), with an average follow-up of 3 months. In the patient with generalized dystonia, the lower-extremity Barry-Albright Dystonia Scale score decreased from 8 to 0, and the overall score decreased from 32 to 13. All parents noted increased ease in caregiving, particularly in terms of positioning, transfers, and changing. The mean daily enteral baclofen dose decreased from 47 mg preoperatively to 24.5 mg postoperatively (p < 0.001). Three patients developed wound dehiscence, 2 of whom had concurrent infections.
CONCLUSIONS
Lumbosacral VDR is safe, is effective for tone control, and can provide quality of life improvements in patients with medically refractory lower-limb mixed hypertonia. Lumbosacral VDR can be considered for palliative tone control in nonambulatory patients with more severe CP. Larger studies with longer follow-ups are necessary to further determine safety and long-term benefits in these patients.
Topics: Humans; Cerebral Palsy; Female; Rhizotomy; Male; Child; Retrospective Studies; Muscle Hypertonia; Adolescent; Treatment Outcome; Child, Preschool; Lower Extremity; Lumbosacral Region; Quality of Life
PubMed: 38823052
DOI: 10.3171/2024.3.FOCUS2472 -
JBJS Case Connector Apr 2024An 11-year-old girl with intact neurology presented with a lumbosacral kyphotic deformity due to healed tuberculosis. Radiological imaging showed sagittal balanced spine...
CASE
An 11-year-old girl with intact neurology presented with a lumbosacral kyphotic deformity due to healed tuberculosis. Radiological imaging showed sagittal balanced spine with compensatory thoracic lordosis and cervical kyphosis. She underwent L4 and L5 posterior vertebral column resection (PVCR) with posterior instrumentation from L2 to pelvis. The patient demonstrated immediate correction of compensatory curves postoperatively. At 3-year follow-up, she returned to her activities of daily living with Oswestry Disability Index and Scoliosis Research Society scores of 12 and 4.8% respectively.
CONCLUSION
Pediatric post-tubercular deformities in the lumbosacral region are rare. They can cause secondary changes in other regions, such as the loss of thoracic kyphosis or cervical lordosis. These deformities should be addressed at an early age to prevent structural changes in compensatory curves.
Topics: Humans; Female; Child; Kyphosis; Lumbar Vertebrae; Tuberculosis, Spinal; Lumbosacral Region
PubMed: 38820193
DOI: 10.2106/JBJS.CC.24.00066 -
Cancer Medicine Jun 2024We endeavored to introduce a novel scoring system (Lumbar Functional Index, LFI) capable of evaluating lumbar function in pelvic bone sarcoma patients who underwent...
AIMS
We endeavored to introduce a novel scoring system (Lumbar Functional Index, LFI) capable of evaluating lumbar function in pelvic bone sarcoma patients who underwent surgical resection and spinal pelvic fixation, while simultaneously identifying the incidence, outcomes, and risk factors of lumbar function impairment among these populations.
PATIENTS AND METHODS
A cohort of 304 primary bone sarcoma patients were recruited. The LFI was created based on the Oswestry Dysfunction Index (ODI) and Japanese Orthopaedic Association (JOA) scores. Lumbar function impairment was defined as LFI score ≥ 18 points, which was identified as high LFI. Demographic data, clinical characteristics, and oncological outcomes were analyzed.
RESULTS
The cohort included chondrosarcoma (39.8%), osteosarcoma (29.9%), Ewing sarcoma (8.6%), bone-derived undifferentiated pleomorphic sarcoma (7.2%), giant cell tumor of bone (7.2%), chordoma (2.3%), and other bone sarcomas (5.0%). The LFI score exhibited significant negative correlation with common scoring systems of bone sarcoma. The incidence of high LFI was 23.0%. Patients with high LFI demonstrated a higher prevalence of type I + II + III + IV pelvic tumor, more sacrificed nerve roots and bilateral lumbar spine fixation during surgery, while lower percentage of R0 resection and local control of pelvic tumor. Decreased median overall survival (30 vs. 52 months, p < 0.001) and recurrence-free survival (14 vs. 24 months, p < 0.001) time were observed in these patients. Type I + II + III + IV pelvic tumor and sacrificed nerve roots≥2 were identified as risk factors for high LFI, while R0 resection and local control were identified as protective factors.
CONCLUSION
The LFI scoring system exhibited a significant negative correlation to current scoring systems. High LFI patients had worse prognosis and distinct characteristics. The risk factors of high LFI included type I + II + III + IV pelvic tumor and sacrificed nerve roots≥2, and the protective factors included R0 resection and local control.
Topics: Humans; Male; Female; Bone Neoplasms; Adult; Middle Aged; Adolescent; Young Adult; Pelvic Bones; Sarcoma; Lumbar Vertebrae; Aged; Child; Risk Factors; Osteosarcoma; Lumbosacral Region
PubMed: 38819113
DOI: 10.1002/cam4.7282 -
Chiropractic & Manual Therapies May 2024Lumbar spinal manipulative therapy (SMT) is a common intervention used to treat low back pain (LBP); however, the exact neurophysiological mechanisms of SMT reducing... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Lumbar spinal manipulative therapy (SMT) is a common intervention used to treat low back pain (LBP); however, the exact neurophysiological mechanisms of SMT reducing pain measured through pain pressure threshold (PPT) have not been fully explored beyond an immediate timeframe (e.g., immediately or five-minutes following) referencing a control group. Therefore, the purpose of this study was to investigate the neurophysiological effects of lumbar SMT compared to deactivated ultrasound using PPT immediately following and 30-minutes following SMT.
METHODS
A longitudinal, randomized controlled trial design was conducted between September to October 2023. Fifty-five participants were randomized into a control group of deactivated ultrasound (n = 29) or treatment group of right sidelying lumbar SMT (n = 26). PPT, recorded at the right posterior superior iliac spine (PSIS), was documented for each participant in each group prior to intervention, immediately, and 30-minutes after. A repeated measures ANOVA, with a post-hoc Bonferroni adjustment, was used to assess within-group and between-group differences in PPT. The significance level was set at a < 0.05 a priori.
RESULTS
Statistically significant differences were found between the deactivated ultrasound and lumbar SMT groups immediately (p = .05) and 30-minutes (p = .02) following intervention. A significant difference in the lumbar SMT group was identified from baseline to immediately following (p < .001) and 30-minutes following (p < .001), but no differences between immediately following and 30-minutes following intervention (p = .10). The deactivated ultrasound group demonstrated a difference between baseline and immediately after intervention with a reduced PPT (p = .003), but no significant difference was found from baseline to 30-minutes (p = .11) or immediately after intervention to 30-minutes (p = 1.0).
CONCLUSION
A right sidelying lumbar manipulation increased PPT at the right PSIS immediately after that lasted to 30-minutes when compared to a deactivated ultrasound control group. Future studies should further explore beyond the immediate and short-term neurophysiological effects of lumbar SMT to validate these findings.
TRIAL REGISTRATION
This study was retrospectively registered on 4 December 2023 in ClinicalTrials (database registration number NCT06156605).
Topics: Humans; Manipulation, Spinal; Female; Male; Adult; Pain Threshold; Low Back Pain; Young Adult; Lumbar Vertebrae; Longitudinal Studies; Healthy Volunteers; Lumbosacral Region; Middle Aged; Pressure
PubMed: 38811985
DOI: 10.1186/s12998-024-00540-5 -
Georgian Medical News Mar 2024Highlighting the prospective evaluation of the surgical outcome of pedicle screw usage in the treatment of degenerative lumbar spine disease in fifty-five patients who...
Highlighting the prospective evaluation of the surgical outcome of pedicle screw usage in the treatment of degenerative lumbar spine disease in fifty-five patients who were treated consecutively via a posterior surgical approach with pedicle screw fixation. A total of 55 consecutive patients with degenerative lumbosacral spine disease were treated at AL Mosul Teaching Hospital. Patients were included if they were between the ages of 25 and 60 years, they were admitted to the hospital with chronic back pain and or radicular pain and had a pedicle anatomy (based on a preoperative X-ray) that could accommodate surgical stabilization with PS instrumentation and fusion. Posterior surgical stabilization of the degenerative lumbar spine disease with pedicular screws was done and before discharge, each patient underwent a postoperative X-ray of the lumbosacral spine. In this series 55 patients were operated on for pedicular screw fixation with connecting bar, all patients underwent decompression except 2 cases, 47 patients with 2-level fixation and 8 patients with 3-level fixation. All patients' pain disappeared or became less, as well as paraesthesia.10 patients with lower limb neurological deficits improved. Only 5 of all patients are re-operated (three due to displacement, one due to a broken screw, and one due to a loose screw), 3 patients developed Dural tears and were treated by suturing with muscle patch, no vascular injury, no post-operative infection seen but one patient developed DVT post-operatively treated conservatively. Pedicle screw fixation facilitates the bone-fusion process, and its use is associated with a relatively low complication rate. The application of pedicle screws can be technically demanding; a thorough working knowledge of spinal anatomy and the principles of pedicle screw insertion will greatly contribute to their safe and accurate placement. These devices should be used when there is any feature of instability or due to iatrogenic instability after wide bone removal or after the destruction of facet joints.
Topics: Humans; Middle Aged; Adult; Lumbar Vertebrae; Female; Male; Treatment Outcome; Pedicle Screws; Spinal Fusion; Bone Screws; Prospective Studies; Decompression, Surgical; Lumbosacral Region
PubMed: 38807404
DOI: No ID Found -
Pain Physician May 2024Lumbar medial branch blocks (MBB) are some of the most commonly performed pain procedures in the United States. Diagnostic MBBs are performed to confirm if the generator... (Observational Study)
Observational Study
BACKGROUND
Lumbar medial branch blocks (MBB) are some of the most commonly performed pain procedures in the United States. Diagnostic MBBs are performed to confirm if the generator of low back pain is the facet joint. However, with diagnostic injections, false positive blocks may occur.
OBJECTIVES
Our prospective observational study aims to investigate the effects of midazolam sedation on patients' perceived intensity of pain relief following lumbar MBB.
STUDY DESIGN
This is a single-center multi-site prospective observational study registered on clinicaltrials.gov (NCT04453449).
SETTING
The study was approved by the Henry Ford Health System Institutional Review Board (IRB) in June 2020 (IRB# 14010) and registered on clinicaltrials.gov in July 2020 (NCT04453449). This manuscript adheres to the applicable EQUATOR STROBE guidelines for an observational cohort study.
METHODS
Patients that underwent MBB without sedation were compared to sedated patients. Patients were asked to complete the Numeric Rating Scale (NRS) at baseline, one day after their diagnostic blocks, as well as 4 weeks and 8 weeks after their lumbar radiofrequency ablation (RFA). The primary outcome is the difference between baseline NRS pain scores and the lowest reported score in the 8 hours following MBB. For patients who proceed to RFA, the frequency of false positive blocks was evaluated. A patient was considered to have a false positive block when they failed to achieve 50% pain relief from RFA after 2 successful sequential MBBs.
RESULTS
There was no significant difference in the NRS pain score change between the sedated and non-sedated groups for diagnostic block one (P = 0.167) and diagnostic block 2 (P = 0.6145). There was no significant difference of false positive rates between non-sedation and sedation patients at 4-weeks post-RFA (P = 0.7178) and at 8-weeks post-RFA (P = 1.000).
LIMITATIONS
Some of the limitations of this study include its nonrandomized design, patient self-reported pain scores, as well as the small variability in the injection technique of proceduralists and in the anatomical location of the injection site.
CONCLUSIONS
This study showed that midazolam did not change patients' perceived intensity of pain following MBB, as well as false positive rates after RFA. Larger studies are required to draw definitive conclusions.
Topics: Humans; Low Back Pain; Prospective Studies; Zygapophyseal Joint; Female; Male; Middle Aged; Nerve Block; Adult; Midazolam; Hypnotics and Sedatives; Lumbar Vertebrae; Pain Measurement; Lumbosacral Region; Aged
PubMed: 38805536
DOI: No ID Found -
Sensors (Basel, Switzerland) May 2024This study validates real-time biofeedback for lumbopelvic control training in baseball. The lumbopelvic region is crucial for generating kinetic energy in pitching....
BACKGROUND
This study validates real-time biofeedback for lumbopelvic control training in baseball. The lumbopelvic region is crucial for generating kinetic energy in pitching. Real-time biofeedback enhances training effectiveness and reduces injury risk. The validity and reliability of this system were examined.
PURPOSE
This study was to investigate the validity and reliability of the real-time biofeedback system for lumbopelvic control training.
METHODS
Twelve baseball players participated in this study, with data collected in two sessions separated by a week. All participants needed to do the lateral slide exercise and single-leg squat exercise in each session. Pelvic angles detected by the real-time biofeedback system were compared to the three-dimensional motion capture system (VICON) during training sessions. Additionally, pelvic angles measured by the biofeedback system were compared between the two training sessions.
RESULTS
The real-time biofeedback system exhibited moderate to strong correlations with VICON in both exercises: lateral slide exercise ( = 0.66-0.88, < 0.05) and single-leg squat exercise ( = 0.70-0.85, < 0.05). Good to excellent reliability was observed between the first and second sessions for both exercises: lateral slide exercise (ICC = 0.76-0.97) and single-leg squat exercise (ICC = 0.79-0.90).
CONCLUSIONS
The real-time biofeedback system for lumbopelvic control training, accurately providing the correct pelvic angle during training, could enhance training effectiveness.
Topics: Humans; Male; Biofeedback, Psychology; Baseball; Young Adult; Pelvis; Lumbosacral Region; Adult; Reproducibility of Results
PubMed: 38793912
DOI: 10.3390/s24103060 -
Medicina (Kaunas, Lithuania) May 2024: This study aimed to evaluate the mid-term effectiveness and safety of a combined ultrasound (US) and fluoroscopy (FL)-guided approach in comparison to US-guided and... (Comparative Study)
Comparative Study
Combined Ultrasound and Fluoroscopy versus Ultrasound versus Fluoroscopy-Guided Caudal Epidural Steroid Injection for the Treatment of Unilateral Lower Lumbar Radicular Pain: A Retrospective Comparative Study.
: This study aimed to evaluate the mid-term effectiveness and safety of a combined ultrasound (US) and fluoroscopy (FL)-guided approach in comparison to US-guided and FL-guided caudal epidural steroid injections (CESI) for treating unilateral lower lumbar radicular pain. : A total of 154 patients who underwent CESI between 2018 and 2022 were included. Patients were categorized into three groups based on the guidance method: combined US and FL (n = 51), US-guided (n = 51), and FL-guided (n = 52). The study design was retrospective case-controlled, utilizing patient charts and standardized forms to assess clinical outcomes, adverse events, complications during the procedures. : In all groups, Oswestry Disability Index and Verbal Numeric Scale scores improved at 1, 3, and 6 months after the last injection, with no significant differences between groups ( < 0.05). The treatment success rate at all time points was also similar among the groups. Logistic regression analysis showed that injection method, cause, sex, age, number of injections, and pain duration did not independently predict treatment success. Blood was aspirated before injection in 2% (n = 1), 13.5% (n = 7), and 4% (n = 2) of patients in the combined US and FL groups, FL-guided groups, and US-guided groups, respectively. Intravascular contrast spread was detected in one patient in the combined method groups and seven in the FL-guided groups. : When comparing pain reduction and functional improvement, there was no significant difference between the three methods. The combined method took less time compared to using FL alone. The combined approach also showed a lower occurrence of intravascular injection compared to using FL alone. Moreover, blood vessels at the injection site can be identified with an ultrasound using the combined method. Given these advantages, it might be advisable to prioritize the combined US- and FL-guided therapy when administering CESI for patients with unilateral lumbar radicular pain.
Topics: Humans; Retrospective Studies; Fluoroscopy; Female; Male; Middle Aged; Injections, Epidural; Steroids; Low Back Pain; Adult; Aged; Ultrasonography, Interventional; Treatment Outcome; Radiculopathy; Case-Control Studies; Lumbar Vertebrae; Ultrasonography; Lumbosacral Region
PubMed: 38792992
DOI: 10.3390/medicina60050809 -
Medicina (Kaunas, Lithuania) Apr 2024: The aim of this retrospective study was to evaluate the effect of lumbar sympathetic block (LSB) on pain scores, Fontaine Classification, and collateral perfusion...
Retrospective Evaluation of the Effect of Lumbar Sympathetic Blockade on Pain Scores, Fontaine Classification, and Collateral Perfusion Status in Patients with Lower Extremity Peripheral Arterial Disease.
: The aim of this retrospective study was to evaluate the effect of lumbar sympathetic block (LSB) on pain scores, Fontaine Classification, and collateral perfusion status in patients with lower extremity peripheral artery disease (PAD), in whom revascularization is impossible. : Medical records of 21 patients with PAD who underwent LSB with a combination of local anesthetics, steroids, and patient follow-up forms containing six-month follow-ups between January 2020 and March 2021 were retrospectively reviewed. Numeric Rating Scale (NRS), Pain Detect Questionnaire (PDQ) scores, Fontaine Classification Stages, and collateral perfusion status (collateral diameter and/or development of neovascularization) evaluated by arterial color Doppler Ultrasound (US) from the medical records and follow-up forms of the patients were reviewed. : NRS and PDQ scores were significantly lower, and regression of the Fontaine Classification Stages was significantly better after the procedure at the first, third, and sixth month than at the baseline values ( < 0.001). Only four patients (19%) had collaterals before the procedure. An increase in the collateral diameter after LSB was noted in three out of four patients. Before the procedure, 17 patients had no prominent collateral. However, in thirteen of these patients, after LSB, neovascularization was detected during the six-month follow-up period (three patients in the first month, seven patients in the third month, and thirteen patients in the sixth month). The number of patients evolving neovascularization after LSB was found to be statistically significant at the third and sixth months compared to the initial examination ( < 0.001). : LSB with the use of local anesthetic and steroids in patients with lower extremity PAD not only led to lower NRS and PDQ scores, but also resulted in regressed Fontaine Classification Stages and better collateral perfusion status.
Topics: Humans; Female; Male; Retrospective Studies; Aged; Peripheral Arterial Disease; Middle Aged; Lower Extremity; Pain Measurement; Autonomic Nerve Block; Collateral Circulation; Lumbosacral Region; Anesthetics, Local; Aged, 80 and over
PubMed: 38792864
DOI: 10.3390/medicina60050682 -
Cureus Apr 2024Low back pain (LBP) is a prevalent musculoskeletal issue characterized by discomfort in the lumbosacral region. LBP localized between the 12th thoracic vertebra and...
Management of Low Back Pain With Concurrent Hamstring Tightness: A Case Report Highlighting the Efficacy of Proprioceptive Neuromuscular Facilitation, Mulligan's Two-Leg Rotation Technique, and Exercise Regimen.
Low back pain (LBP) is a prevalent musculoskeletal issue characterized by discomfort in the lumbosacral region. LBP localized between the 12th thoracic vertebra and inferior gluteal folds is common and often lacks a clear etiology. Various factors contribute to LBP, including increased lumbar lordosis, diminished abdominal muscle strength, reduced back extensor muscle endurance, and flexibility limitations in the back extensors, iliopsoas, and hamstrings. Treatment modalities for LBP encompass surgical intervention, pharmacotherapy, lumbar injections, psychotherapy, chiropractic care, and physiotherapy, with manual therapy being a prominent approach. Physiotherapists employ a spectrum of manual techniques, including mobilization, manipulation, and massage, to address LBP. Hamstring flexibility plays a pivotal role in spinal mechanics, and tight or shortened hamstrings can exacerbate LBP. Mulligan's techniques, notably the two-leg rotation (TLR) technique, are valuable interventions for addressing hamstring tightness in cases of LBP. Proprioceptive neuromuscular facilitation (PNF) was also used to manage pain and improve strength. This case report outlines the management of a 32-year-old male presenting with LBP and hamstring tightness coupled with core muscle weakness. Through comprehensive assessment and physiotherapeutic interventions, significant improvements were observed in pain intensity, lumbar range of motion, disability, straight leg raise (SLR), and core muscle strength following a three-week physiotherapy intervention.
PubMed: 38779251
DOI: 10.7759/cureus.58705