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Folia Morphologica May 2024The lateral femoral cutaneous nerve is derived from the dorsal branches of the L2 and L3 spinal nerves. It travels across the pelvis and heads towards the anterior...
BACKGROUND
The lateral femoral cutaneous nerve is derived from the dorsal branches of the L2 and L3 spinal nerves. It travels across the pelvis and heads towards the anterior superior iliac spine. It passes under the lateral part of the inguinal ligament and then divides into two branches, which are responsible for sensory innervation of the anterolateral and lateral skin of the thigh. However, the course of this nerve can vary morphologically. Numerous differences have been observed in its exit from the pelvis and in the number of its main trunks and branches. Additionally, its angle with the inguinal ligament and its placement in relation to other structures (such as the femoral artery, femoral nerve, and the sartorius and iliacus muscles) also vary. All of these variants have potential clinical implications. Therefore, the aim of this review is to present the morphological variability of the lateral cutaneous nerve and to explore how these anatomical differences can introduce clinical concerns.
MATERIALS AND METHODS
Presented review of the literature was written based on over 30 studies. Comprehensive literature search was done using PubMed in order to study the morphological variability of lateral femoral cutaneous nerve (LFCN). To be included in this review studies needed to be meet certain criteria: been published before December 2023, present information valuable to this paper (variability of lateral femoral cutaneous nerve/clinical significance). The search included how LFCN vary either among fetuses and adults in the aim of providing more complex information about the variability of this nerve. During the search key words as following were used. No particular references were excluded from the analysis. All relevant studies were included, and citation tracking was used to identify publications.
RESULTS
This review presents the description of variability of LFCN and its potential clinical impact. In the review differences in adult and fetuses were considered, morphological variability were divided into 4 groups: the origin of the nerve, the way it leaves the pelvis, the branching pattern, the angle between LFCN and surrounding structures and then, clinical significance were considered basing on available literature.
PubMed: 38757494
DOI: 10.5603/fm.98624 -
MedRxiv : the Preprint Server For... May 2024Thoracic insufficiency syndrome (TIS) affects ventilatory function due to spinal and thoracic deformities limiting lung space and diaphragmatic motion. Corrective...
PURPOSE
Thoracic insufficiency syndrome (TIS) affects ventilatory function due to spinal and thoracic deformities limiting lung space and diaphragmatic motion. Corrective orthopedic surgery can be used to help normalize skeletal anatomy, restoring lung space and diaphragmatic motion. This study employs free-breathing dynamic MRI (dMRI) and quantifies the 3D motion of each hemi-diaphragm surface in normal and TIS patients, and evaluates effects of surgical intervention.
MATERIALS AND METHODS
In a retrospective study of 149 pediatric patients with TIS and 190 healthy children, we constructed 4D images from free-breathing dMRI and manually delineated the diaphragm at end-expiration (EE) and end-inspiration (EI) time points. We automatically selected 25 points uniformly on each hemi-diaphragm surface, calculated their relative velocities between EE and EI, and derived mean velocities in 13 homologous regions for each hemi-diaphragm to provide measures of regional 3D hemi-diaphragm motion. T-testing was used to compare velocity changes before and after surgery, and to velocities in healthy controls.
RESULTS
The posterior-central region of the right hemi-diaphragm exhibited the highest average velocity post-operatively. Posterior regions showed greater velocity changes after surgery in both right and left hemi-diaphragms. Surgical reduction of thoracic Cobb angle displayed a stronger correlation with changes in diaphragm velocity than reduction in lumbar Cobb angle. Following surgery, the anterior regions of the left hemi-diaphragm tended to approach a more normal state.
CONCLUSION
Quantification of regional motion of the 3D diaphragm surface in normal subjects and TIS patients via free-breathing dMRI is feasible. Derived measurements can be assessed in comparison to normal subjects to study TIS and the effects of surgery.
PubMed: 38746409
DOI: 10.1101/2024.05.02.24306551 -
EClinicalMedicine Jun 2024Previous studies have indicated that glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1RAs) may enhance bone formation and have neutral or beneficial effects on...
BACKGROUND
Previous studies have indicated that glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1RAs) may enhance bone formation and have neutral or beneficial effects on fracture risk. We evaluated the effect of the GLP-1RA semaglutide on the bone formation marker Procollagen type I N-terminal propeptide (PINP) in adults with increased fracture risk.
METHODS
This randomised, placebo-controlled, double-blinded, phase 2 clinical trial was conducted at two public hospitals in Denmark. We enrolled 64 men and women with increased fracture risk based on a T-score < -1.0 at the total hip or lumbar spine and/or low-energy fracture within three years of recruitment. Participants were randomised (1:1) to receive once-weekly subcutaneous semaglutide 1.0 mg or placebo. The primary outcome was changes in plasma (P)-PINP from baseline to week 52. Primary and safety outcomes were assessed and evaluated for all participants. This trial is complete and registered with ClinicalTrials.gov, NCT04702516.
FINDINGS
Between March 24 and December 8, 2021, 55 (86%) postmenopausal women and nine men with a mean age of 63 years (SD 5.5) and BMI of 27.5 kg/m (SD 4.5) were enrolled. There was no effect on changes in P-PINP from baseline to week 52 between the two groups (estimated treatment difference (ETD) semaglutide versus placebo 3.8 μg/L [95% CI -5.6 to 13.3]; p = 0.418), and no difference in P-PINP levels between groups at week 52 (semaglutide 64.3 μg/L versus placebo 62.3 μg/L [95% CI -10.8 to 15.0]; p = 0.749). The secondary outcomes showed higher plasma levels of bone resorption marker Collagen type I cross-linked C-terminal telopeptide (P-CTX) in the semaglutide group than in the placebo group (ETD 166.4 ng/L [95% CI 25.5-307.3]; p = 0.021). Compared to placebo, lumbar spine and total hip areal bone mineral densities (aBMD) were lower in the semaglutide group after 52 weeks ((ETD lumbar spine -0.018 g/cm [95% CI -0.031 to -0.005]; p = 0.007); ETD total hip -0.020 g/cm ([95% CI -0.032 to -0.008]; p = 0.001). Treatment differences in femoral neck aBMD were not observed ([95% CI [-0.017 to 0.006]; p = 0.328). Further, body weight was lower in the semaglutide group than in the placebo group after 52 weeks (ETD -6.8 kg [95% CI -8.8 to -4.7]; p < 0.001). Thirty-one [97%] in the semaglutide group and 18 [56%] in the placebo group experienced at least one adverse event, including four serious events (two in each group). No episodes of hypoglycaemia or deaths were reported.
INTERPRETATION
In adults with increased fracture risk, semaglutide once weekly did not increase bone formation based on the bone formation marker P-PINP. The observed increase in bone resorption in the semaglutide group may be explained by the accompanying weight loss.
FUNDING
Region of Southern Denmark, Novo Nordisk Foundation, and Gangsted Foundation. Novo Nordisk provided the investigational drug and placebo.
PubMed: 38737002
DOI: 10.1016/j.eclinm.2024.102624 -
PloS One 2024Many lumbar spine diseases are caused by defects or degeneration of lumbar intervertebral discs (IVD) and are usually diagnosed through inspection of the patient's...
Many lumbar spine diseases are caused by defects or degeneration of lumbar intervertebral discs (IVD) and are usually diagnosed through inspection of the patient's lumbar spine MRI. Efficient and accurate assessments of the lumbar spine are essential but a challenge due to the size of the clinical radiologist workforce not keeping pace with the demand for radiology services. In this paper, we present a methodology to automatically annotate lumbar spine IVDs with their height and degenerative state which is quantified using the Pfirrmann grading system. The method starts with semantic segmentation of a mid-sagittal MRI image into six distinct non-overlapping regions, including the IVD and vertebrae regions. Each IVD region is then located and assigned with its label. Using geometry, a line segment bisecting the IVD is determined and its Euclidean distance is used as the IVD height. We then extract an image feature, called self-similar color correlogram, from the nucleus of the IVD region as a representation of the region's spatial pixel intensity distribution. We then use the IVD height data and machine learning classification process to predict the Pfirrmann grade of the IVD. We considered five different deep learning networks and six different machine learning algorithms in our experiment and found the ResNet-50 model and Ensemble of Decision Trees classifier to be the combination that gives the best results. When tested using a dataset containing 515 MRI studies, we achieved a mean accuracy of 88.1%.
Topics: Humans; Magnetic Resonance Imaging; Lumbar Vertebrae; Intervertebral Disc; Intervertebral Disc Degeneration; Machine Learning; Male; Female; Middle Aged; Image Processing, Computer-Assisted; Adult
PubMed: 38728318
DOI: 10.1371/journal.pone.0302067 -
Ticks and Tick-borne Diseases Jul 2024Definite diagnosis of Lyme neuroborreliosis (LNB) requires investigation of serum and cerebrospinal fluid (CSF). Thus, lumbar puncture is necessary, and requires...
Definite diagnosis of Lyme neuroborreliosis (LNB) requires investigation of serum and cerebrospinal fluid (CSF). Thus, lumbar puncture is necessary, and requires administration of sedating drugs in children. This study aimed to investigate if a pattern of different inflammatory biomarkers in serum could contribute to the selection of children for lumbar puncture in suspected LNB. Patients were included from a cohort of children who was previously investigated for LNB including serum and CSF sampling during the years 2010-2014. The multiplex proximity extension assay (PEA) inflammation panel Target 96 (Olink Bioscience, Uppsala, Sweden) was used to examine 92 biomarkers in serum. Based on the presence of CSF pleocytosis and Borrelia-specific antibodies, patients were divided into a definite LNB group (n=61) and a non-LNB control group (n=58). Following PEA and statistical analysis with multivariate logistic regression, five biomarkers remained significant (p < 0.001), which were included in a calculation of protein index. The index biomarkers were CST5, IL-15RA, CXCL10, DNER and CX3CL1. A receiver operating characteristic curve was constructed from the index, which showed an 80 % sensitivity and 81 % specificity. Area under the curve was 0.889. We offer evidence that, with further refinements, patterns of serum biomarkers might help identify those children more or less likely to have LNB, perhaps ultimately decreasing the need for lumbar punctures.
Topics: Humans; Lyme Neuroborreliosis; Child; Biomarkers; Male; Female; Adolescent; Child, Preschool
PubMed: 38723400
DOI: 10.1016/j.ttbdis.2024.102349 -
European Journal of Translational... May 2024Lumbar spinal stenosis (LSS) occurs when bony, ligamentous, and synovial elements of the lower axial spine degenerate and overgrow, compressing neural and vascular...
Lumbar spinal stenosis (LSS) occurs when bony, ligamentous, and synovial elements of the lower axial spine degenerate and overgrow, compressing neural and vascular elements in the spinal canal. Compression can cause static back pain, radicular lower extremity pain, or neurogenic claudication. Radiological and clinical findings are needed to diagnose lumbar stenosis. In this framework, caudal epidural steroid injection (ESI) is a standard treatment. The volume injected and needle positioning are the main issues that could compromise the effectiveness of the epidural injection. However, ultrasound-guided caudal epidural injections have become more common in recent years. Since Klocke and colleagues described the ultra-sound-guided caudal block in 2003, it has grown in popularity. Multiple ethnic studies have reported ultrasound-guided caudal injection success rates of 96.9-100%. Color Doppler ultrasonography can also determine if a drug solution reaches the lumbosacral region. We enrolled 42 patients with lumbar spinal stenosis, persistent lumbosciatalgia, and neurogenic claudicatio unresponsive to painkillers who were not surgical candidates. Each patient receives four weekly injections for four weeks. If the patient responds to treatment but still has pain, monthly injections are needed to reach and maintain the benefit. Treatment will be changed if the patient does not respond after 4 caudal injections. Sterile caudal epidural injections are performed with ultrasound guidance and a spinal needle 21G. Triamcinolone 40 mg, levobupivacaine 10 mg, and physiological solution 10 ml are delivered. Each patient received an average of 4 injective treatments (4±2, Means 4, SD 2). Data analysis shows that the treatment reduced pain significantly before and after therapy, which persisted after 3 months. Caudal epidural injection is one of the most common conservative treatments for chronic low back pain with radiculopathy, and lidocaine alone or with steroids is effective. In this framework, the two main literature issues about caudal epidural injection effectiveness on lumbar pain are correct. Therefore, 10 ml is suitable and effective for treating symptoms without side effects. Pain reduction of over 50% from start to finish and three-month follow-up have shown significant results in pain control and disability improvement. Finally, caudal epidural injection for lumbar spinal stenosis symptoms is effective, safe, and provides long-term pain relief.
PubMed: 38713057
DOI: 10.4081/ejtm.2024.12167 -
European Journal of Radiology Open Jun 2024To evaluate an optimized deep leaning-based image post-processing technique in lumbar spine MRI at 0.55 T in terms of image quality and image acquisition time.
Advanced deep learning-based image reconstruction in lumbar spine MRI at 0.55 T - Effects on image quality and acquisition time in comparison to conventional deep learning-based reconstruction.
OBJECTIVES
To evaluate an optimized deep leaning-based image post-processing technique in lumbar spine MRI at 0.55 T in terms of image quality and image acquisition time.
MATERIALS AND METHODS
Lumbar spine imaging was conducted on 18 patients using a 0.55 T MRI scanner, employing conventional (CDLR) and advanced (ADLR) deep learning-based post-processing techniques. Two musculoskeletal radiologists visually evaluated the images using a 5-point Likert scale to assess image quality and resolution. Quantitative assessment in terms of signal intensities (SI) and contrast ratios was performed by region of interest measurements in different body-tissues (vertebral bone, intervertebral disc, spinal cord, cerebrospinal fluid and autochthonous back muscles) to investigate differences between CDLR and ADLR sequences.
RESULTS
The images processed with the advanced technique (ADLR) were rated superior to the conventional technique (CDLR) in terms of signal/contrast, resolution, and assessability of the spinal canal and neural foramen. The interrater agreement was moderate for signal/contrast (ICC = 0.68) and good for resolution (ICC = 0.77), but moderate for spinal canal and neuroforaminal assessability (ICC = 0.55). Quantitative assessment showed a higher contrast ratio for fluid-sensitive sequences in the ADLR images. The use of ADLR reduced image acquisition time by 44.4%, from 14:22 min to 07:59 min.
CONCLUSIONS
Advanced deep learning-based image reconstruction algorithms improve the visually perceived image quality in lumbar spine imaging at 0.55 T while simultaneously allowing to substantially decrease image acquisition times.
CLINICAL RELEVANCE
Advanced deep learning-based image post-processing techniques (ADLR) in lumbar spine MRI at 0.55 T significantly improves image quality while reducing image acquisition time.
PubMed: 38711678
DOI: 10.1016/j.ejro.2024.100567 -
Journal of Orthopaedic Surgery and... May 2024This study aimed to investigate an early diagnostic method for lumbar disc degeneration (LDD) and improve its diagnostic accuracy.
PURPOSE
This study aimed to investigate an early diagnostic method for lumbar disc degeneration (LDD) and improve its diagnostic accuracy.
METHODS
Quantitative biomarkers of the lumbar body (LB) and lumbar discs (LDs) were obtained using nuclear magnetic resonance (NMR) detection technology. The diagnostic weights of each biological metabolism indicator were screened using the factor analysis method.
RESULTS
Through factor analysis, common factors such as the LB fat fraction, fat content, and T2* value of LDs were identified as covariates for the diagnostic model for the evaluation of LDD. This model can optimize the accuracy and reliability of LDD diagnosis.
CONCLUSION
The application of biomarker quantification methods based on NMR detection technology combined with factor analysis provides an effective means for the early diagnosis of LDD, thereby improving diagnostic accuracy and reliability.
Topics: Humans; Intervertebral Disc Degeneration; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Biomarkers; Female; Adult; Middle Aged; Factor Analysis, Statistical; Reproducibility of Results; Early Diagnosis
PubMed: 38711140
DOI: 10.1186/s13018-024-04726-8 -
Sports Medicine and Health Science Jun 2024This scoping review aims (1) to map the literature dealing with neurophysiological and biomechanical aspects of back problems in athletes in order to identify valid... (Review)
Review
This scoping review aims (1) to map the literature dealing with neurophysiological and biomechanical aspects of back problems in athletes in order to identify valid risk-factors for their prevention, plus (2) to identify gaps in the existing research and propose suggestions for future studies. A literature search conducted with Scopus, Web of Science, MEDLINE and Cochrane Library was completed by Elsevier, SpringerLink and Google Scholar. The main neurophysiological risk factors identified leading to back problems in athletes are neuromuscular imbalance, increased muscle fatigability, muscle dysfunction and impaired motor control, whilst biomechanical risk factors include maladaptive spinal, spinopelvic and lower limb kinematics, side-to-side imbalances in axial strength and hip rotation range of motion, spinal overloading and deficits in movement pattern. However, most studies focused on back pain in the lumbar region, whereas less attention has been paid to thoracic and cervical spine problems. The range of sports where this topic has been studied is relatively small. There is a lack of research in sports in which the core muscles are highly involved in specific movements such as lifting weights or trunk rotations. A limited number of studies include female athletes and master athletes of both genders. In addition to chronic back pain patients, it is equally important to conduct research on healthy athletes with a predisposition to spine problems. Investigators should focus their empirical work on identifying modifiable risk factors, predict which athletes are at risk for back problems, and develop personalized sport-specific assessment tools and targeted prevention strategies for them. This review was registered using the Open Science Framework Registries (https://osf.io/ha5n7).
PubMed: 38708324
DOI: 10.1016/j.smhs.2023.12.006 -
International Journal of Sports... 2024Thoracic rotation mobility is crucial for athletes in rotational sports such as baseball, golf, and swimming to maintain the proper biomechanics associated with the...
BACKGROUND
Thoracic rotation mobility is crucial for athletes in rotational sports such as baseball, golf, and swimming to maintain the proper biomechanics associated with the sport. Accurate differentiation between normal mobility and active and passive physiological deficits in the thoracic region is critical for identifying the need for intervention to the thorax.
PURPOSE
To establish the reliability and discriminant validity of visual estimation of thorax rotation range of motion across clinicians of differing experience levels in determining normal mobility and active or passive physiological deficits when utilizing the quadruped lumbar-locked position.
STUDY DESIGN
Cross-sectional.
METHODS
Thirty-eight subjects (21 female, 17 male) with a mean age of 27 years ± 6.67 were assessed with the quadruped lumbar-locked thorax rotation test by three examiners with various clinical experience in real-time and again one week later. Bilateral active and passive lumbar-locked thorax rotation mobility was assessed by all raters and categorized as "Unrestricted" (≥50°) or "Restricted" (<50°) while a research assistant simultaneously measured the motion with a digital inclinometer. All raters were blinded to the results. All results were analyzed for intra-rater reliability and agreement.
RESULTS
Test-retest intra-rater reliability ranged from 0.55-0.72 and percent absolute agreement ranged from 0.82-0.89. Inter-rater reliability ranged from 0.45-0.59 while percent absolute agreement between raters ranged from 0.74-0.84. There was a significant difference in range of motion between "Unrestricted" and "Restricted" categories for both active (Unrestricted=54.6-58.9; Restricted=40.4-44.4; p<0.001) and passive motion (Unrestricted=61.3-63.5; Restricted=39.2-39.7; p<0.001). The only interaction effect was for passive left rotation [Rater A Restricted x ® =34.3(30.4-38.2); Rater C Restricted (x ) ®=43.8(41.3-46.4); p=.000].
CONCLUSION
The quadruped lumbar-locked thorax rotation test demonstrates moderate to substantial test-retest intra-rater and inter-rater reliability regardless of clinical experience. The quadruped lumbar-locked thorax rotation test can accurately discriminate between individuals with active and passive physiological deficits regardless of rater experience using visual estimation.
LEVEL OF EVIDENCE
3b.
PubMed: 38707852
DOI: 10.26603/001c.116154