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Journal of Ultrasound in Medicine :... Mar 2017To determine the intrarater reliability and precision of lumbar multifidus and transversus abdominis thickness measurements using freehand sonography in a range of...
OBJECTIVES
To determine the intrarater reliability and precision of lumbar multifidus and transversus abdominis thickness measurements using freehand sonography in a range of static and dynamic conditions.
METHODS
Fifteen asymptomatic participants performed a range of exercises while sonography was used to measure absolute muscle thickness and changes in muscle thickness from rest. Exercise conditions included the abdominal drawing-in maneuver, active straight leg raise, contralateral arm lift, both unloaded and loaded, treadmill walking, and using the Functional Readaptive Exercise Device. Intraday and interday reliability was assessed by intraclass correlation coefficients, and the standard error of measurement was used to assess measurement precision.
RESULTS
Good to excellent reliability was achieved for absolute transversus abdominis and lumbar multifidus thickness in all conditions. Measurement precision for absolute lumbar multifidus thickness was ≤2.8 mm for the unloaded contralateral arm lift, ≤1.8 mm for the loaded contralateral arm lift, ≤3.1 mm for treadmill walking, and ≤3.8 mm for the Functional Readaptive Exercise Device; for absolute transversus abdominis thickness, precision was ≤0.6 mm for the abdominal drawing-in maneuver, ≤0.5 mm for the active straight leg raise, ≤0.7 mm for treadmill walking, and ≤0.5 mm for the Functional Readaptive Exercise Device. Good to excellent reliability was achieved for relative transversus abdominis and lumbar multifidus thickness in all conditions. Measurement precision for relative lumbar multifidus thickness was ≤3.7% for the unloaded contralateral arm lift, ≤3.8% for the loaded contralateral arm lift, ≤6.3% for treadmill walking, and ≤7.6% for the Functional Readaptive Exercise Device; for relative transversus abdominis thickness, precision was ≤13.6% for the abdominal drawing-in maneuver, ≤6.9% for the active straight leg raise, ≤11.1% for treadmill walking, and ≤7.2% for the Functional Readaptive Exercise Device.
CONCLUSIONS
Acceptable reliability and precision of measurement is achieved for absolute and relative measures of deep spinal muscle thickness using freehand sonography in relatively static and dynamic exercises.
Topics: Abdominal Muscles; Adult; Back Muscles; Body Weights and Measures; Exercise; Female; Humans; Lumbosacral Region; Male; Muscle Contraction; Observer Variation; Reference Values; Reproducibility of Results; Ultrasonography
PubMed: 28150321
DOI: 10.7863/ultra.16.03059 -
Annals of Biomedical Engineering Jul 2022Prolonged microgravity results in muscle atrophy, especially among the anti-gravity spinal muscles. How individual paravertebral muscle groups change in size and...
Prolonged microgravity results in muscle atrophy, especially among the anti-gravity spinal muscles. How individual paravertebral muscle groups change in size and composition with spaceflight needs further exploration. This study investigates lumbar spine musculature changes among six crewmembers on long-duration space missions using non-invasive measurement of muscle changes with magnetic resonance imaging (MRI). Pre- and post-flight lumbar images were analyzed for changes in cross-sectional area, volume, and fat infiltration of the psoas (PS), quadratus lumborum (QL), and paraspinal [erector spinae and multifidus (ES + MF)] muscles using mixed models. Crewmembers used onboard exercise equipment, including a cycle ergometer (CEVIS), treadmill (T2/COLBERT), and the advanced resistive exercise device (ARED). Correlations were used to assess muscle changes related to exercise modality. There was substantial variability in muscle changes across crewmembers but collectively a significant decrease in paraspinal area (- 9.0 ± 4.8%, p = 0.04) and a significant increase in QL fat infiltration (7.3 ± 4.1%, p = 0.05). More CEVIS time may have protected against PS volume loss (p = 0.05) and PS fat infiltration (p < 0.01), and more ARED usage may have protected against ES + MF volume loss (p = 0.05). Crewmembers using modern onboard exercise equipment may be less susceptible to muscle changes. However, variability between crewmembers and muscle size and quality losses suggest additional research is needed to ensure in-flight countermeasures preserve muscle health.
Topics: Lumbar Vertebrae; Lumbosacral Region; Magnetic Resonance Imaging; Paraspinal Muscles; Space Flight
PubMed: 35459964
DOI: 10.1007/s10439-022-02968-3 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Jun 2022To review and evaluate the technical advantages and disadvantages and research progress of percutaneous endoscopic lumbar interbody fusion. (Review)
Review
OBJECTIVE
To review and evaluate the technical advantages and disadvantages and research progress of percutaneous endoscopic lumbar interbody fusion.
METHODS
The domestic and foreign related research literature on percutaneous endoscopic lumbar interbody fusion was extensively consulted. The advantages, disadvantages, and effectiveness were summarized. And the development trend of this technology was prospected.
RESULTS
Compared with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), percutaneous endoscopic lumbar interbody fusion has less intraoperative and postoperative bleeding, better improvement of low back pain in the early stage after operation, and similar long-term effectiveness, fusion rate, and incidence of complication, but a longer learning curve. The operation time of biportal and large-channel uniportal endoscopic lumbar fusion is close to that of MIS-TLIF, but the operation time of small-channel uniportal endoscopic fusion is longer than that of MIS-TLIF.
CONCLUSION
Percutaneous endoscopic lumbar interbody fusion has the advantages of less trauma and good effectiveness, but its learning curve is long, and indications should be strictly selected for this operation. In the future, with the continuous development and complementation of various endoscopic fusion technologies, this technology will gain better application prospects.
Topics: Humans; Lumbar Vertebrae; Lumbosacral Region; Minimally Invasive Surgical Procedures; Retrospective Studies; Spinal Fusion; Treatment Outcome
PubMed: 35712920
DOI: 10.7507/1002-1892.202202075 -
Medicine Sep 2022Intraspinal choristoma is a relatively uncommon intervertebral canal tumor. Prior to our reports, only 2 cases of intraspinal choristoma had been reported. Because this...
RATIONALE
Intraspinal choristoma is a relatively uncommon intervertebral canal tumor. Prior to our reports, only 2 cases of intraspinal choristoma had been reported. Because this disease is not common and looks like a mass of fatty tissue on the magnetic resonance imaging (MRI), intraspinal choristoma can be easily misdiagnosed as teratomas or lipomas (like the case of this article presenting) without a pathology report. So if a lumber intraspinal lesion is discovered in a clinical examination, intraspinal choristoma should be considered as a differential diagnosis. We present a case of intraspinal choristoma that is unlike any other reported case.
PATIENT CONCERNS
A 35-year-old woman with left lower extremity hypoesthesia and burning-like pain in the lumbar region for 1 month visited the local hospital for plain lumbar spine MRI. The patient was diagnosed with a lumbar space-occupying lesion. A second plain lumbar spine MRI scan and a MRI scan with enhancement were performed in our hospital to confirm the presence of a congenital lipoma in the spinal canal. A postoperative biopsy of the lumbar spinal mass indicated that the mass was an intraspinal choristoma located in the spinal canal.
DIAGNOSIS
Intraspinal choristoma.
INTERVENTION
The lesion was surgically removed, and follow-up plain and enhanced MRI images of the patient's lumbar spine were obtained.
OUTCOMES
After surgery, the patient no longer experienced the burning pain in her lumbar region or the left lower extremity hypoesthesia when the patient was discharged. And there was no evidence of recurrence 2 years after the surgery.
LESSONS
The MRI presentation of intraspinal choristoma is similar to intraspinal lipoma. Therefore, a pathological assessment is critical to provide an accurate diagnosis.
Topics: Adult; Choristoma; Female; Humans; Hypesthesia; Lipoma; Lumbar Vertebrae; Lumbosacral Region
PubMed: 36123848
DOI: 10.1097/MD.0000000000029350 -
PloS One 2021High-level dressage horses regularly perform advanced movements, requiring coordination and force transmission between front and hind limbs across the thoracolumbosacral...
High-level dressage horses regularly perform advanced movements, requiring coordination and force transmission between front and hind limbs across the thoracolumbosacral region. This study aimed at quantifying kinematic differences in dressage horses when ridden in sitting trot-i.e. with additional load applied in the thoracolumbar region-compared with trotting in-hand. Inertial sensors were glued on to the midline of the thoracic (T) and lumbar (L) spine at T5, T13, T18, L3 and middle of the left and right tubera sacrale of ten elite dressage horses (Mean±SD), age 11±1 years, height 1.70±0.10m and body mass 600±24kg; first trotted in-hand, then ridden in sitting trot on an arena surface by four Grand Prix dressage riders. Straight-line motion cycles were analysed using a general linear model (random factor: horse; fixed factor: exercise condition; covariate: stride time, Bonferroni post hoc correction: P<0.05). Differential roll, pitch and yaw angles between adjacent sensors were calculated. In sitting trot, compared to trotting in-hand, there was increased pitch (mean±S.D), (in-hand, 3.9 (0.5°, sitting trot 6.3 (0.3°, P = <0.0001), roll (in-hand, 7.7 (1.1°, sitting trot 11.6 (0.9°, P = 0.003) and heading values (in-hand, 4.2 (0.8), sitting trot 9.5 (0.6°, P = <0.0001) in the caudal thoracic and lumbar region (T18-L3) and a decrease in heading values (in-hand, 7.1 (0.5°, sitting trot 5.2 (0.3°, P = 0.01) in the cranial thoracic region (T5-T13). Kinematics of the caudal thoracic and lumbar spine are influenced by the rider when in sitting trot, whilst lateral bending is reduced in the cranial thoracic region. This biomechanical difference with the addition of a rider, emphasises the importance of observing horses during ridden exercise, when assessing them as part of a loss of performance assessment.
Topics: Animals; Biomechanical Phenomena; Female; Horses; Lumbosacral Region; Male; Rotation; Running; Thorax
PubMed: 33956858
DOI: 10.1371/journal.pone.0251144 -
International Biomechanics Dec 2020Psychological pressure during sports competition disturbs the ideal physical movement and causes injury. Baseball batting frequently causes trunk injuries. This study...
Psychological pressure during sports competition disturbs the ideal physical movement and causes injury. Baseball batting frequently causes trunk injuries. This study aimed to examine the influence of psychological pressure on the lumbar kinematics and trunk muscle activity during the baseball batting. Fourteen collegiate baseball players participated in this study. The participants performed bat swings under three different psychological conditions (non-pressure, pressure, and emphasized pressure). The lumbar kinematics and trunk muscle activity were measured during each bat swing. One- and two-way analyses of variance were performed to compare the lumbar kinematics and trunk muscle activity among different psychological pressure conditions. The lumbar flexion angle throughout the bat swing in the swing phase, from the moment of ground contact of the lead foot to the moment of ball contact, was significantly larger under the pressure and emphasized pressure conditions than under the non-pressure condition (P<0.05). The bilateral lumbar erector spinae (LES) activities in the swing and follow-through phases were significantly higher under the emphasized pressure condition than under the non-pressure condition (P<0.05). These results indicate that the baseball batting under psychological pressure influenced the lumbar kinematics and bilateral LES activities and may be related to the development of low back pain.
Topics: Analysis of Variance; Athletes; Baseball; Biomechanical Phenomena; Foot; Humans; Low Back Pain; Lumbosacral Region; Male; Muscle, Skeletal; Stress, Psychological; Torso; Young Adult
PubMed: 33998388
DOI: 10.1080/23335432.2020.1811765 -
Chiropractic & Manual Therapies Mar 2023This review aimed to identify variables influencing clinicians' application of spinal manipulative therapy (SMT) for persistent spine pain after lumbar surgery (PSPS-2).... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This review aimed to identify variables influencing clinicians' application of spinal manipulative therapy (SMT) for persistent spine pain after lumbar surgery (PSPS-2). We hypothesized markers of reduced clinical/surgical complexity would be associated with greater odds of applying SMT to the lumbar region, use of manual-thrust lumbar SMT, and SMT within 1-year post-surgery as primary outcomes; and chiropractors would have increased odds of using lumbar manual-thrust-SMT compared to other practitioners.
METHODS
Per our published protocol, observational studies describing adults receiving SMT for PSPS-2 were included. PubMed, Web of Science, Scopus, OVID, PEDro, and Index to Chiropractic Literature were searched from inception to January 6, 2022. Individual patient data (IPD) were requested from contact authors when needed for selection criteria. Data extraction and a customized risk-of-bias rubric were completed in duplicate. Odds ratios (ORs) for primary outcomes were calculated using binary logistic regressions, with covariates including age, sex, symptom distribution, provider, motion segments, spinal implant, and surgery-to-SMT interval.
RESULTS
71 articles were included describing 103 patients (mean age 52 ± 15, 55% male). The most common surgeries were laminectomy (40%), fusion (34%), and discectomy (29%). Lumbar SMT was used in 85% of patients; and of these patients was non-manual-thrust in 59%, manual-thrust in 33%, and unclear in 8%. Clinicians were most often chiropractors (68%). SMT was used > 1-year post-surgery in 66% of cases. While no primary outcomes reached significance, non-reduced motion segments approached significance for predicting use of lumbar-manual-thrust SMT (OR 9.07 [0.97-84.64], P = 0.053). Chiropractors were significantly more likely to use lumbar-manual-thrust SMT (OR 32.26 [3.17-327.98], P = 0.003). A sensitivity analysis omitting high risk-of-bias cases (missing ≥ 25% IPD) revealed similar results.
CONCLUSIONS
Clinicians using SMT for PSPS-2 most often apply non-manual-thrust SMT to the lumbar spine, while chiropractors are more likely to use lumbar-manual-thrust SMT relative to other providers. As non-manual-thrust SMT may be gentler, the proclivity towards this technique suggests providers are cautious when applying SMT after lumbar surgery. Unmeasured variables such as patient or clinician preferences, or limited sample size may have influenced our findings. Large observational studies and/or international surveys are needed for an improved understanding of SMT use for PSPS-2. Systematic review registration PROSPERO (CRD42021250039).
Topics: Adult; Humans; Male; Middle Aged; Aged; Female; Manipulation, Spinal; Lumbosacral Region; Low Back Pain; Lumbar Vertebrae
PubMed: 36895028
DOI: 10.1186/s12998-023-00481-5 -
Turkish Journal of Medical Sciences Feb 2022The aim of this cadaveric study was to investigate the erector spinae plane block (ESPB) in lumbar region and to elucidate the possible mechanisms of action of these...
BACKGROUND
The aim of this cadaveric study was to investigate the erector spinae plane block (ESPB) in lumbar region and to elucidate the possible mechanisms of action of these injections in lumbar radicular pain by means of detecting expected dye dispersion to the neural structures.
METHODS
Ultrasound-guided lumbar ESPB was performed in three formaldehyde-embalmed human cadavers. For this purpose, a 10 mL of methylene blue was injected into the fascial space between the L4 transverse process and the erector spinae muscles. T hen, the cadavers were dissected, the cephalocaudal and lateral spread of the dye was examined, and the involvement of the dorsal rami, dorsal root ganglia and ventral rami were analyzed. The distribution into the epidural space was also evaluated.
RESULTS
The involvement of the dorsal rami was found to extend up to the T12 level and down to the L5 spinal nerves. Although dye dispersion was detected on the dorsal root ganglion in all specimens, it was found to be limited to one or two levels, unlike the dorsal rami. In half of the specimens, distribution to the ventral ramus and posterior epidural space was observed.
Topics: Humans; Animals; Female; Nerve Block; Lumbosacral Region; Chickens; Thoracic Vertebrae; Cadaver
PubMed: 34773689
DOI: 10.3906/sag-2107-83 -
International Journal of Molecular... Jul 2020Damage to the annulus fibrosus (AF), the outer region of the intervertebral disc (IVD), results in an undesirable condition that may accelerate IVD degeneration causing... (Review)
Review
Damage to the annulus fibrosus (AF), the outer region of the intervertebral disc (IVD), results in an undesirable condition that may accelerate IVD degeneration causing low back pain. Despite intense research interest, attempts to regenerate the IVD have failed so far and no effective strategy has translated into a successful clinical outcome. Of particular significance, the failure of strategies to repair the AF has been a major drawback in the regeneration of IVD and nucleus replacement. It is unlikely to secure regenerative mediators (cells, genes, and biomolecules) and artificial nucleus materials after injection with an unsealed AF, as IVD is exposed to significant load and large deformation during daily activities. The AF defects strongly change the mechanical properties of the IVD and activate catabolic routes that are responsible for accelerating IVD degeneration. Therefore, there is a strong need to develop effective therapeutic strategies to prevent or reconstruct AF damage to support operational IVD regenerative strategies and nucleus replacement. By the way of this review, repair and regenerative strategies for AF reconstruction, their current status, challenges ahead, and future outlooks were discussed.
Topics: Animals; Annulus Fibrosus; Humans; Intervertebral Disc; Intervertebral Disc Degeneration; Lumbosacral Region; Regeneration
PubMed: 32664453
DOI: 10.3390/ijms21144889 -
Chiropractic & Manual Therapies Feb 2022International guidelines do not recommend routine imaging, including magnetic resonance imaging (MRI), and seek to guide clinicians only to refer for imaging based on...
BACKGROUND
International guidelines do not recommend routine imaging, including magnetic resonance imaging (MRI), and seek to guide clinicians only to refer for imaging based on specific indications. Despite this, several studies show an increase in the use of MRI among patients with low back pain (LBP) and an imbalance between appropriate versus inappropriate use of MRI for LBP. This study aimed to investigate to what extent referrals from general practice for lumbar MRI complied with clinical guideline recommendations in a Danish setting, contributing to the understanding and approaches to lumbar MRI for all clinicians managing LBP in the primary sector.
MATERIALS AND METHODS
From 2014 to 2018, all referrals for lumbar MRI were included from general practitioners in the Central Denmark Region for diagnostic imaging at a public regional hospital. A modified version of the American College of Radiology Imaging Appropriateness Criteria for LBP was used to classify referrals as appropriate or inappropriate, based on the unstructured text in the GPs' referrals. Appropriate referrals included fractures, cancer, symptoms persisting for more than 6 weeks of non-surgical treatment, previous surgery, candidate for surgery or suspicion of cauda equina. Inappropriate referrals were sub-classified as lacking information about previous non-surgical treatment and duration.
RESULTS
Of the 3772 retrieved referrals for MRI of the lumbar spine, 55% were selected and a total of 2051 referrals were categorised. Approximately one quarter (24.5%) were categorised as appropriate, and 75.5% were deemed inappropriate. 51% of the inappropriate referrals lacked information about previous non-surgical treatment, and 49% had no information about the duration of non-surgical treatment. Apart from minor yearly fluctuations, there was no change in the distribution of appropriate and inappropriate MRI referrals from 2014 to 2018.
CONCLUSION
The majority of lumbar MRI referrals (75.5%) from general practitioners for lumbar MRI did not fulfil the ACR Imaging Appropriateness Criteria for LBP based on the unstructured text of their referrals. There is a need for referrers to include all guideline-relevant information in referrals for imaging. More research is needed to determine whether this is due to patients not fulfilling guideline recommendations or simply the content of the referrals.
Topics: Humans; Low Back Pain; Lumbosacral Region; Magnetic Resonance Imaging; Primary Health Care; Referral and Consultation
PubMed: 35193634
DOI: 10.1186/s12998-022-00418-4