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Spine Aug 2020
Topics: Gene Expression; Humans; Lumbar Vertebrae; Lumbosacral Region; Paraspinal Muscles
PubMed: 32675621
DOI: 10.1097/BRS.0000000000003576 -
Journal of Biomechanics Aug 2023Lumbar joint compression forces have been linked to the development of chronic low back pain, which is specially present in occupational environments. Offline...
Lumbar joint compression forces have been linked to the development of chronic low back pain, which is specially present in occupational environments. Offline methodologies for lumbosacral joint compression force estimation are not commonly integrated in occupational or medical applications due to the highly time-consuming and complex post-processing procedures. Hence, applications such as real-time adjustment of assistive devices (i.e., back-support exoskeletons) for optimal modulation of compression forces remains unfeasible. Here, we present a real-time electromyography (EMG)-driven musculoskeletal model, capable of estimating accurate lumbosacral joint moments and plausible compression forces. Ten participants performed box-lifting tasks (5 and 15 kg) with and without the Laevo Flex back-support exoskeleton using squat and stoop lifting techniques. Lumbosacral kinematics and EMGs from abdominal and thoracolumbar muscles were used to drive, in real-time, subject-specific EMG-driven models, and estimate lumbosacral joint moments and compression forces. Real-time EMG-model derived moments showed high correlations (R = 0.76 - 0.83) and estimation errors below 30% with respect to reference inverse dynamic moments. Compared to unassisted lifting conditions, exoskeleton liftings showed mean lumbosacral joint moments and compression forces reductions of 11.9 - 18.7 Nm (6 - 12% of peak moment) and 300 - 450 N (5 - 10%), respectively. Our modelling framework was capable of estimating in real-time, valid lumbosacral joint moments and compression forces in line with in vivo experimental data, as well as detecting the biomechanical effects of a passive back-support exoskeleton. Our presented technology may lead to a new class of bio-protective robots in which personalized assistance profiles are provided based on subject-specific musculoskeletal variables.
Topics: Humans; Electromyography; Lifting; Exoskeleton Device; Lumbosacral Region; Biomechanical Phenomena; Abdominal Muscles
PubMed: 37499430
DOI: 10.1016/j.jbiomech.2023.111727 -
The Journal of International Medical... Aug 2022Ewing sarcoma (ES) is a highly aggressive bone and soft tissue tumor that occurs mainly in young children and adolescents and is associated with primary and metastatic... (Review)
Review
Ewing sarcoma (ES) is a highly aggressive bone and soft tissue tumor that occurs mainly in young children and adolescents and is associated with primary and metastatic disease. Intramedullary ES (either primary or secondary) is rare, and the ideal management remains inconclusive. We herein report intramedullary and extramedullary metastatic ES in a single patient. A 46-year-old woman was referred to our outpatient clinic from the oncology clinic with progressive paraparesis and paresthesia for 1 week prior to presentation. She had developed left clavicular ES 2 years earlier for which surgery and chemoradiotherapy had been performed. At the present evaluation, she was diagnosed with intramedullary thoracic and lumbar extradural masses. Thoracic surgery was performed, and a biopsy of the lesion was obtained. The diagnosis of ES was confirmed histopathologically, and she underwent adjuvant chemotherapy. Her neurological status did not improve after surgery, and she underwent rehabilitation and physical therapy. The lumbar lesion resolved with chemotherapy. Metastasis of ES to the spinal cord, especially intramedullary lesions, is extremely rare, and there is no standard management guideline. However, surgical decompression and adjuvant chemotherapy are the main treatments in these cases.
Topics: Adolescent; Chemotherapy, Adjuvant; Child; Child, Preschool; Female; Humans; Lumbosacral Region; Middle Aged; Sarcoma, Ewing
PubMed: 35938475
DOI: 10.1177/03000605221108095 -
Medicine Oct 2017Lumbosacral hemivertebrae causes unique problems as early trunk decompensation and long compensatory curve above. There are only a few reports on it. This case series is... (Review)
Review
Lumbosacral hemivertebrae causes unique problems as early trunk decompensation and long compensatory curve above. There are only a few reports on it. This case series is a fair supplement in the literatures.To evaluate the clinical and radiological outcomes of lumbosacral hemivertebrae resection through 1-stage posterior approach.Between 2005 and 2014, a consecutive series of congenital scoliosis due to lumbosacral hemivertebrae underwent hemivertebrae excision through 1-stage posterior only approach. Demographic, operative, radiological, and quality of life data were reviewed.The mean lumbosacral curve was 29 ± 7° preoperatively, 10 ± 3° postoperatively, and 13 ± 5° at the final follow up. The final correction rate was 55 ± 9%. The gravity trunk shift was 11 ± 3 mm preoperatively, 37 ± 12 mm (range, 6-49 mm) postoperatively, 14 ± 9 mm at final follow up. The rib cage shift was 36 ± 12 mm preoperatively, 19 ± 5 mm postoperatively, and 15 ± 4 mm at the final follow up. The mean blood loss was 527 ± 125 mL and the mean surgery time was 336 ± 98 minutes. The mean follow up period was 41 ± 6 months. Two patients underwent transient neurological complications, 2 had wound bad healing, and 1 got wound infection. No pseudoarthrosis and instrumentation failure was observed.One-stage posterior hemivertebrae excision could gain reasonable outcome. It is crucial to completely resect the hemivertebrae and the Y-shaped disc. Bending the rod to appropriate lordosis is helpful to close the convex side. Early surgical intervene is a preferred choice to restore the trunk balance and avoid extensive fusion. The neurological complication rate is high. Convex radiculopathy is often caused by retraction, it could recover at follow up.
Topics: Bone Diseases, Developmental; Child; Child, Preschool; Diskectomy; Female; Follow-Up Studies; Humans; Lumbar Vertebrae; Lumbosacral Region; Male; Retrospective Studies; Scoliosis; Treatment Outcome
PubMed: 29069034
DOI: 10.1097/MD.0000000000008393 -
Pain Physician 2008A previous study examined the relationship between the sacral inclination angle (SIA), lumbosacral angle (LSA) and sacral horizontal angle (SHA) and spinal mobility in... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
A previous study examined the relationship between the sacral inclination angle (SIA), lumbosacral angle (LSA) and sacral horizontal angle (SHA) and spinal mobility in acute low back pain and chronic low back pain patients. We chose to investigate the lumbar lordosis angle, segmental lumbar lordosis angle, SIA, LSA and SHA in acute and chronic low back pain (LBP) patients as well as the correlation between spinal stability and these angles.
OBJECTIVES
To investigate the biomechanics of the lumbosacral spine region in acute and chronic LBP patients, as well as to examine the correlation between spinal stability and lumbosacral angles.
STUDY DESIGN
Randomized controlled evaluation
SETTING
Physical Medicine and Rehabilitation outpatient clinic
METHODS
Sixty participants with LBP were recruited and categorized as either acute LBP (pain < 3 months) or chronic LBP (pain > 6 months), with 30 subjects in each group. All subjects underwent standing, lateral lumbosacral x-rays, which were analyzed for lumbar stability, SIA, LSA, SHA, lumbar lordosis angle and segmental lumbar lordosis angles.
RESULTS
The mean age of the ALBP subjects was 41.00 +/- 11.63 (18 - 66) and that of the chronic LBP subjects 49.26 +/- 15.6 (22-74), with females comprising 50% of the acute LBP group and 73.3% of the chronic LBP group. Lumbar stability was observed in 62.1% of acute LBP patients and 36.8% of chronic LBP patients. A statistically significant difference was found between the 2 groups in terms of age, gender, and lumbar stability. There was no statistical difference regarding SIA, LSA, SHA, total and segmental lordosis angles between acute and chronic LBP patients (p>0.05).
CONCLUSION
We were unable to find a difference between the radiological values for the shape of the SIA, LSA, SHA, and total and segmental lordosis as noted on screening x-ray techniques regarding the occurrence of acute or chronic LBP, but a statistically significant difference was found for lumbar stability. Further extensive studies are needed to examine lumbar stability and its relationship between angles of lumbosacral region.
Topics: Adolescent; Adult; Aged; Biomechanical Phenomena; Female; Humans; Low Back Pain; Lumbosacral Region; Male; Manipulation, Spinal; Middle Aged; Pain Measurement; Pliability; Posture; Range of Motion, Articular
PubMed: 18690279
DOI: No ID Found -
European Spine Journal : Official... Oct 2020To test the vertical posterior vertebral angles (VPVA) of the most caudal lumbar segments measured on EOS to identify and classify the lumbosacral transitional vertebra...
PURPOSE
To test the vertical posterior vertebral angles (VPVA) of the most caudal lumbar segments measured on EOS to identify and classify the lumbosacral transitional vertebra (LSTV).
METHODS
We reviewed the EOS examinations of 906 patients to measure the VPVA at the most caudal lumbar segment (cVPVA) and at the immediately proximal segment (pVPVA), with dVPVA being the result of their difference. Mann-Whitney, Chi-square, and ROC curve statistics were used.
RESULTS
172/906 patients (19%) had LSTV (112 females, mean age: 43 ± 21 years), and 89/172 had type I LSTV (52%), 42/172 type II (24%), 33/172 type III (19%), and 8/172 type IV (5%). The cVPVA and dVPVA in non-articulated patients were significantly higher than those of patients with LSTV, patients with only accessory articulations, and patients with only bony fusion (all p < .001). The cVPVA and dVPVA in L5 sacralization were significantly higher than in S1 lumbarization (p < .001). The following optimal cutoff was found: cVPVA of 28.2° (AUC = 0.797) and dVPVA of 11.1° (AUC = 0.782) to identify LSTV; cVPVA of 28.2° (AUC = 0.665) and dVPVA of 8° (AUC = 0.718) to identify type II LSTV; cVPVA of 25.5° (AUC = 0.797) and dVPVA of - 7.5° (AUC = 0.831) to identify type III-IV LSTV; cVPVA of 20.4° (AUC = 0.693) and dVPVA of - 1.8° (AUC = 0.665) to differentiate type II from III-IV LSTV; cVPVA of 17.9° (AUC = 0.741) and dVPVA of - 4.5° (AUC = 0.774) to differentiate L5 sacralization from S1 lumbarization.
CONCLUSION
The cVPVA and dVPVA measured on EOS showed good diagnostic performance to identify LSTV, to correctly classify it, and to differentiate L5 sacralization from S1 lumbarization.
Topics: Adult; Female; Humans; Lordosis; Lumbar Vertebrae; Lumbosacral Region; Male; Middle Aged; Musculoskeletal Abnormalities; Sacrum; Young Adult
PubMed: 32783082
DOI: 10.1007/s00586-020-06565-7 -
Brazilian Journal of Anesthesiology... 2020Hemicorporectomy progresses with hemodynamic and ventilatory repercussions that make anesthesia management definitive to patient outcome.
INTRODUCTION
Hemicorporectomy progresses with hemodynamic and ventilatory repercussions that make anesthesia management definitive to patient outcome.
OBJECTIVE
Report anesthesia approach for a patient with squamous cell carcinoma submitted to urgent hemicorporectomy after an episode of hypovolemic shock.
CASE REPORT
After lesion bleeding, the patient presented hypovolemic shock class 3, and was submitted to urgent procedure under general inhalation anesthesia and intravenous multimodal analgesia, presenting hemodynamic instability requiring massive blood transfusion after spinal cord transection and removal of surgical specimen.
CONCLUSION
Anesthetic management is essential in scenarios such as the one reported to assure patient survival.
Topics: Adult; Amputation, Surgical; Anesthesia; Carcinoma, Squamous Cell; Humans; Lumbosacral Region; Male
PubMed: 32171500
DOI: 10.1016/j.bjan.2019.12.011 -
Sports Medicine (Auckland, N.Z.) Jul 2011Following the onset of maturation, female athletes have a significantly higher risk for anterior cruciate ligament (ACL) injury compared with male athletes. While... (Review)
Review
Following the onset of maturation, female athletes have a significantly higher risk for anterior cruciate ligament (ACL) injury compared with male athletes. While multiple sex differences in lower-extremity neuromuscular control and biomechanics have been identified as potential risk factors for ACL injury in females, the majority of these studies have focused specifically on the knee joint. However, increasing evidence in the literature indicates that lumbo-pelvic (core) control may have a large effect on knee-joint control and injury risk. This review examines the published evidence on the contributions of the trunk and hip to knee-joint control. Specifically, the sex differences in potential proximal controllers of the knee as risk factors for ACL injury are identified and discussed. Sex differences in trunk and hip biomechanics have been identified in all planes of motion (sagittal, coronal and transverse). Essentially, female athletes show greater lateral trunk displacement, altered trunk and hip flexion angles, greater ranges of trunk motion, and increased hip adduction and internal rotation during sport manoeuvres, compared with their male counterparts. These differences may increase the risk of ACL injury among female athletes. Prevention programmes targeted towards trunk and hip neuromuscular control may decrease the risk for ACL injuries.
Topics: Abdomen; Anterior Cruciate Ligament Injuries; Biomechanical Phenomena; Female; Hip Joint; Humans; Knee Joint; Lumbosacral Region; Male; Musculoskeletal Physiological Phenomena; Pelvis; Risk Factors; Sex Factors
PubMed: 21688868
DOI: 10.2165/11589140-000000000-00000 -
Acta Orthopaedica Et Traumatologica... 2015The aim of this anatomical study was to compare the effects of the prone and lateral decubitus positions in endoscopic disc surgery on the Kambin's triangle (KT) and... (Comparative Study)
Comparative Study
OBJECTIVE
The aim of this anatomical study was to compare the effects of the prone and lateral decubitus positions in endoscopic disc surgery on the Kambin's triangle (KT) and neural foramina zones in the lumbosacral region.
METHODS
The study included 32 healthy volunteers (16 females and 16 males). Bilateral KT areas (KTA) and neural foraminal areas (FA) of the L4-L5 and L5-S1 levels in the prone and lateral decubitus positions were calculated depending on the freehand region of interest measurements on magnetic resonance images. KTA and FA values for each side and level in the prone and lateral decubitus positions were compared.
RESULTS
Mean left KTA value in the prone and right lateral decubitus positions was 0.58 cm(2) and 0.69 cm(2), respectively, for L4-L5; and 0.69 cm(2) and 0.78 cm(2), respectively, for L5-S1 levels. Mean right KTA values in the prone and left lateral decubitus positions were 0.54 cm(2) and 0.65 cm(2) for L4-L5; and 0.69 cm(2) and 0.81 cm(2) for L5-S1, respectively. The differences in the KTA between prone and lateral decubitus positions for both levels and both sides were statistically significant (p=0.05). Only the difference in the FA between the prone and lateral decubitus positions at L5-S1 level on the right side was statistically significant (p=0.05).
CONCLUSION
The KTA is wider in the lateral decubitus position than in the prone position at the levels of L4-L5 and L5-S1.
Topics: Algorithms; Female; Humans; Lumbar Vertebrae; Lumbosacral Region; Magnetic Resonance Imaging; Male; Patient Positioning; Prone Position; Sacrum; Supine Position
PubMed: 25803250
DOI: 10.3944/AOTT.2015.14.0233 -
The Bone & Joint Journal Aug 2015The interaction between the lumbosacral spine and the pelvis is dynamically related to positional change, and may be complicated by co-existing pathology. This review... (Review)
Review
The interaction between the lumbosacral spine and the pelvis is dynamically related to positional change, and may be complicated by co-existing pathology. This review summarises the current literature examining the effect of sagittal spinal deformity on pelvic and acetabular orientation during total hip arthroplasty (THA) and provides recommendations to aid in placement of the acetabular component for patients with co-existing spinal pathology or long spinal fusions. Pre-operatively, patients can be divided into four categories based on the flexibility and sagittal balance of the spine. Using this information as a guide, placement of the acetabular component can be optimal based on the type and significance of co-existing spinal deformity.
Topics: Acetabulum; Arthroplasty, Replacement, Hip; Hip Prosthesis; Humans; Lumbosacral Region; Pelvic Bones; Posture; Spinal Diseases
PubMed: 26224815
DOI: 10.1302/0301-620X.97B8.35700