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Folia Morphologica 2021Lumbar facet joints (LFJs) are diarthrodial joints which provide articulation between two adjacent lumbar vertebrae. LFJs represent complex anatomic structures with... (Review)
Review
Lumbar facet joints (LFJs) are diarthrodial joints which provide articulation between two adjacent lumbar vertebrae. LFJs represent complex anatomic structures with multifaceted biomechanical and functional characteristics. They are theorized as structures of crucial clinical significance since their degenerative morphologic alterations are frequently related to emergence of low back pain. Despite the emerging interest in describing LFJs anatomy in recent years, precise description of LFJs innervation remains controversial. In this comprehensive review, anatomy and biomechanical importance of LFJs and associated adjacent extra-articular structures are thoroughly presented. Furthermore, LFJs innervation in respect to current literature data is punctually analysed. Knowledge of anatomy and innervation LFJs of critical importance for clinicians and spine surgeons, so that patients are properly evaluated and related therapeutic procedures are rationally performed.
Topics: Humans; Low Back Pain; Lumbar Vertebrae; Lumbosacral Region; Zygapophyseal Joint
PubMed: 33084010
DOI: 10.5603/FM.a2020.0122 -
Scientific Reports Apr 2020Lumbar spondylolysis generally occurs in adolescent athletes. Bony union can be expected with conservative treatment, however, the fracture does not heal in some cases....
Lumbar spondylolysis generally occurs in adolescent athletes. Bony union can be expected with conservative treatment, however, the fracture does not heal in some cases. When the fracture becomes a pseudoarthrosis, spondylolysis patients have the potential to develop isthmic spondylolisthesis. A cross-sectional study was performed to determine the incidence of spondylolysis and spondylolisthesis, and to elucidate when and how often spondylolisthesis occurs in patients with or without spondylolysis. Patients undergoing computed tomography (CT) scans of abdominal or lumbar regions for reasons other than low back pain were included (n = 580). Reconstruction CT images were obtained, and the prevalence of spondylolysis and spondylolisthesis were evaluated. Of the 580 patients, 37 patients (6.4%) had spondylolysis. Of these 37 patients, 19 patients (51.4%) showed spondylolisthesis, whereas only 7.4% of non-spondylolysis patients showed spondylolisthesis (p < 0.05). When excluding unilateral spondylolysis, 90% (18/20) of spondylolysis patients aged ≥60 years-old showed spondylolisthesis. None of the patients with isthmic spondylolisthesis had received fusion surgery, suggesting that most of these patients didn't have a severe disability requiring surgical treatment. Our results showed that the majority of bilateral spondylolysis patients aged ≥60 years-old show spondylolisthesis, and suggest that spondylolisthesis occurs very frequently and may develop at a younger age when spondylolysis exists.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Athletes; Child; Cross-Sectional Studies; Disease Progression; Female; Humans; Japan; Lumbar Vertebrae; Lumbosacral Region; Male; Middle Aged; Prevalence; Spondylolisthesis; Spondylolysis; Tomography, X-Ray Computed
PubMed: 32317683
DOI: 10.1038/s41598-020-63784-0 -
International Journal of Environmental... Jul 2021Trunk stability exercises that focus on either deep or superficial muscles might produce different effects on lumbar segmental motion. This study compared outcomes in 34... (Randomized Controlled Trial)
Randomized Controlled Trial
The Effects of Core Stabilization Exercise with the Abdominal Drawing-in Maneuver Technique versus General Strengthening Exercise on Lumbar Segmental Motion in Patients with Clinical Lumbar Instability: A Randomized Controlled Trial with 12-Month Follow-Up.
Trunk stability exercises that focus on either deep or superficial muscles might produce different effects on lumbar segmental motion. This study compared outcomes in 34 lumbar instability patients in two exercises at 10 weeks and 12 months follow up. Participants were divided into either Core stabilization (deep) exercise, incorporating abdominal drawing-in maneuver technique (CSE with ADIM), or General strengthening (superficial) exercise (STE). Outcome measures were pain, muscle activation, and lumbar segmental motion. Participants in CSE with ADIM had significantly less pain than those in STE at 10 weeks. They showed significantly more improvement of abdominal muscle activity ratio than participants in STE at 10 weeks and 12 months follow-up. Participants in CSE with ADIM had significantly reduced sagittal translation at L4-L5 and L5-S1 compared with STE at 10 weeks. Participants in CSE with ADIM had significantly reduced sagittal translations at L4-L5 and L5-S1 compared with participants in STE at 10 weeks, whereas STE demonstrated significantly increased sagittal rotation at L4-L5. However, at 12 months follow-up, levels of lumbar sagittal translation were increased in both groups. CSE with ADIM which focuses on increasing deep trunk muscle activity can reduce lumbar segmental translation and should be recommended for lumbar instability.
Topics: Abdominal Muscles; Follow-Up Studies; Humans; Joint Instability; Lumbar Vertebrae; Lumbosacral Region; Torso
PubMed: 34360103
DOI: 10.3390/ijerph18157811 -
Dermatology Online Journal Nov 2020Subcutaneous fat necrosis of the newborn is a rare lobular panniculitis. It is characteristic of term or post-term neonates with a history of perinatal compromise or...
Subcutaneous fat necrosis of the newborn is a rare lobular panniculitis. It is characteristic of term or post-term neonates with a history of perinatal compromise or maternal gestational pathology. The cutaneous manifestations consist of erythematous and indurated subcutaneous plaques and nodules located over the dorsal region and the shoulders. Diagnosis is clinical and pathological. Histopathological findings include lobular panniculitis with a lymphohistiocytic inflammatory infiltrate with few neutrophils, fatty necrosis, deposition of radial needle-shaped crystals in the adipocytes, and possible calcification and hemorrhage. The cutaneous ultrasound shows hyperechoic and avascular subcutaneous cellular tissue and acoustic shadows may appear corresponding to calcifications. The clinical differential diagnosis includes sclerema neonatorum and post-corticosteroid panniculitis. Histologically crystal-forming panniculitis conditions are in the differential diagnosis. The disease is usually self-limited but complications such as hypercalcemia, hypoglycemia, hypertriglyceridemia, thrombocytopenia, and anemia may occur. Complications should be ruled out and treated at diagnosis and during follow-up. The most important complication is hypercalcemia.La necrosis grasa subcutánea neonatal es una paniculitis lobulillar infrecuente. Es característica de neonatos a término o postérmino con antecedentes de sufrimiento perinatal o patología gestacional materna. Las manifestaciones cutáneas consisten en placas y nódulos subcutáneos eritematosos e indurados localizados preferentemente en la región dorsal y los hombros. El diagnóstico es clínicopatológico. Los hallazgos histopatológicos comprenden una paniculitis lobulillar con un infiltrado inflamatorio linfohistiocitario con escasos neutrófilos, necrosis grasa, depósito de cristales radiados en los adipocitos y posibles focos de calcificación y hemorragia. En la ecografía cutánea se observa hiperecogenicidad y avascularización del tejido celular subcutáneo y pueden aparecer sombras acústicas posteriores que se correspondencon calcificaciones. El diagnóstico diferencial clínico se debe realizar con el escleredema neonatorum y la paniculitis postesteroidea, e histológicamente con las paniculitis con formación de cristales. La enfermedad suele ser autolimitada pero pueden aparecer complicaciones como la hipercalcemia, la hipoglucemia, la hipertrigliceridemia, latrombocitopenia y la anemia. Las complicaciones deben ser descartadas y tratadas en el diagnóstico y durante el seguimiento. La complicación másimportante es la hipercalcemia.
Topics: Back; Female; Humans; Infant, Newborn; Neck; Subcutaneous Fat; Ultrasonography
PubMed: 33342185
DOI: No ID Found -
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 -
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 -
Medicina (Kaunas, Lithuania) Jul 2023Chronic non-specific low back pain (CNSLBP) is defined as back pain that lasts longer than 12 weeks. Capacitive and resistive electric transfer (TECAR) therapy utilizes... (Randomized Controlled Trial)
Randomized Controlled Trial
Short-Term Effects of Manual Therapy plus Capacitive and Resistive Electric Transfer Therapy in Individuals with Chronic Non-Specific Low Back Pain: A Randomized Clinical Trial Study.
Chronic non-specific low back pain (CNSLBP) is defined as back pain that lasts longer than 12 weeks. Capacitive and resistive electric transfer (TECAR) therapy utilizes radiant energy to generate endogenous heat and is widely used for the treatment of chronic musculoskeletal pain. The aim of this study was to investigate the efficacy of manual therapy (MT) program combined with TECAR therapy in individuals with CNSLBP. Sixty adults with CNSLBP were randomly divided equally into three groups. The first group followed an MT protocol in the lumbar region (MT group), the second group followed the same MT protocol combined with TECAR therapy (MT + TECAR group) using a conventional capacitive electrode as well as a special resistive electrode bracelet, and the third group (control group) received no treatment. Both intervention programs included six treatments over two weeks. Pain in the last 24 h with the Numeric Pain Rating Scale (NPRS), functional ability with the Roland-Morris Disability Questionnaire (RMDQ), pressure pain threshold (PPT) in the lumbar region with pressure algometry, and mobility of the lumbo-pelvic region through fingertip-to-floor distance (FFD) test were evaluated before and after the intervention period with a one-month follow-up. Analysis of variance with repeated measures was applied. In the NPRS score, both intervention groups showed statistically significant differences compared to the control group both during the second week and the one-month follow-up ( < 0.001). Between-group differences were also noticed between the two intervention groups in the second week ( < 0.05). Differences in the RMDQ score were detected between the intervention groups and the control group in the second week and at the one-month follow-up ( < 0.001), while differences between the two intervention groups were only detected at the one-month follow-up ( < 0.001). Regarding the PPT values, differences were found mainly between the MT + TECAR group and the control group and between the MT + TECAR group and the MT group ( < 0.05), with the MT + TECAR group in most cases showing the greatest improvement compared to the other two groups, which remained statistically significant at the one-month follow-up ( < 0.05). Finally, both intervention groups improved the mobility of the lumbo-pelvic region at both time points compared to the control group without, however, statistically significant differences between them ( > 0.05). The application of an MT protocol with TECAR therapy appeared more effective than conventional MT as well as compared to the control group in reducing pain and disability and improving PPT in individuals with CNSLBP. No further improvement was noted in the mobility of the lumbo-pelvic region by adding TECAR to the MT intervention.
Topics: Adult; Humans; Low Back Pain; Musculoskeletal Manipulations; Chronic Pain; Lumbosacral Region; Activities of Daily Living; Treatment Outcome
PubMed: 37512085
DOI: 10.3390/medicina59071275 -
African Journal of Paediatric Surgery :... 2022Rhabdomyosarcoma (RMS) is one of the common malignant soft-tissue sarcomas affecting children. It originates from the embryonic mesenchyme precursor of striated muscle...
Rhabdomyosarcoma (RMS) is one of the common malignant soft-tissue sarcomas affecting children. It originates from the embryonic mesenchyme precursor of striated muscle and is frequently seen in the head-and-neck region, genitourinary system and extremities. Occasionally, it arises from the retroperitoneum, biliary tract and abdomen and is rarely seen in the sacrococcygeal area. A 4-month-male child presented with a nodule over the sacrum. Based on histopathology and immunohistochemical marker studies, a final diagnosis of RMS was rendered. There was no evidence of any teratomatous elements.
Topics: Child; Humans; Male; Rhabdomyosarcoma; Sacrococcygeal Region; Soft Tissue Neoplasms; Teratoma
PubMed: 36018208
DOI: 10.4103/ajps.ajps_69_21 -
Neurology India 2021
Topics: Humans; Intervertebral Disc Degeneration; Lumbar Vertebrae; Lumbosacral Region; Minimally Invasive Surgical Procedures; Spinal Fusion; Treatment Outcome
PubMed: 34747776
DOI: 10.4103/0028-3886.329539 -
Pain Physician Nov 2019Neuroplasty, also known as percutaneous adhesiolysis, is an effective treatment for persistent axial and radicular pain. (Review)
Review
BACKGROUND
Neuroplasty, also known as percutaneous adhesiolysis, is an effective treatment for persistent axial and radicular pain.
OBJECTIVES
One issue of concern is whether hyaluronidase should be used when performing neuroplasty. The objective of this narrative review is to evaluate the current literature relating to hyaluronidase and its role in neuroplasty.
METHODS
The literature relating to hyaluronidase was examined via a search of PubMed and Google Scholar until April 2019, review of the citations of relevant literature, and the authors' knowledge of the literature and activity in the field. The literature was reviewed in light of hyaluronidase's physiologic role, allergenicity, medical uses, and evaluation specifically for neuroplasty.
RESULTS
Hyaluronidase facilitates the spread of medications in the extracellular matrix by breaking down polysaccharides in the interstitial space. While allergic reactions to hyaluronidase have been reported, these reactions occurred with animal-derived preparations. The current human recombinant hyaluronidase does not have any reports of allergic reactions. Laboratory studies show that it does not evoke an immune response. Hyaluronidase has been extensively used in a variety of medical applications, including intrathecal treatment of arachnoiditis.There have been multiple studies reporting benefit from the use of hyaluronidase in interventional procedures. One randomized trial specifically looking at the use of hyaluronidase in neuroplasty found that the addition of hyaluronidase improved pain ratings at 12 months compared to other techniques and decreased the number of procedures needed to gain effect.
LIMITATIONS
There have been limited studies examining the enhanced efficacy of neuroplasty when hyaluronidase is added.
CONCLUSIONS
Because of enhanced efficacy and safety, and because of the decrease in the number of procedures needed to be performed, hyaluronidase should be considered when deciding which medications to use when performing neuroplasty.
KEY WORDS
Neuroplasty, adhesiolysis, hyaluronidase, spinal stenosis, failed back surgery synderome, post lumbar surgery syndrome.
Topics: Humans; Hyaluronoglucosaminidase; Lumbosacral Region; Neurosurgical Procedures; Pain; Pain Management; Spinal Stenosis; Treatment Outcome
PubMed: 31775402
DOI: No ID Found