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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 -
Medicina (Kaunas, Lithuania) Apr 2024: Current evidence confirms that the magnitude of the inter-rectus distance (IRD) is associated with the severity of abdominal pain. Furthermore, evidence exists in the... (Observational Study)
Observational Study
The Relationship between Abdominal Diastasis and Lumbar Pain Pressure Threshold in Women Who Have Given Birth between the Ages of 30 and 45 Years-An Observational Pilot Study.
: Current evidence confirms that the magnitude of the inter-rectus distance (IRD) is associated with the severity of abdominal pain. Furthermore, evidence exists in the literature about the impact abdominal muscles have on low back pain, lumbopelvic pain, breathing and lumbar abdominal strength; however, no studies analysing the level of association between abdominal diastasis and lumbar pain pressure threshold (PPT) exist. The aim of this study was to analyse the level of association between the rectus abdominis distance and pain pressure threshold in the lumbar spinous processes in women who have given birth between the ages of 30 and 45 years. Secondly, it was to study the level of association between the time elapsed since the last delivery and low back pain in women who have given birth between 30 and 45 years of age. : This was a pilot observational study in which 21 females participated. The abdominal diastasis was measured by ultrasound, the pain pressure threshold was assessed by an algometer and the pain perception by the Mc Gill questionnaire. : There was no significant relationship between increased abdominal distance and increased lumbopelvic pain in women who gave birth between the ages of 30 and 45 years. However, there was a correlation between the time that had elapsed since the last delivery and low back pain. : there was a correlation between the time that had elapsed since the last delivery and low back pain. Further studies analysing factors that may perpetuate the chronicity of symptoms, such as lifestyle and intrinsic factors, are needed.
Topics: Humans; Female; Pilot Projects; Adult; Low Back Pain; Middle Aged; Pain Threshold; Rectus Abdominis; Pain Measurement; Diastasis, Muscle; Pressure; Surveys and Questionnaires; Lumbosacral Region
PubMed: 38674236
DOI: 10.3390/medicina60040591 -
Bioengineering (Basel, Switzerland) Mar 2024Percutaneous endoscopic lumbar discectomy (PELD) presents a challenging learning curve, and the correlation between surgeon experience and clinical outcomes remains...
Percutaneous endoscopic lumbar discectomy (PELD) presents a challenging learning curve, and the correlation between surgeon experience and clinical outcomes remains contentious. This retrospective study aimed to compare the outcomes of PELD performed by a single surgeon at beginner and experienced stages. Propensity score matching selected 150 patients (75 per group) with a minimum 3-year follow-up. Clinical and radiological outcomes, perioperative complications, and adverse events were assessed. Baseline characteristics, pain improvement, patient satisfaction, and radiological outcomes did not differ between the groups. However, operation time was longer in the beginner group than in the experienced group (57.5 min [IQR, 50.0-70.0] versus 50.0 min [IQR, 45.0-55.0], < 0.001). The beginner group had higher perioperative complication rates (eight patients [10.7%] versus one patient [1.3%], with a hazard ratio of 8.836 [95% CI, 1.077-72.514], = 0.034) and lower 3-year survival without adverse events (19 patients [25.3%] in the beginner group and 10 patients [13.3%] in the experienced group, = 0.045). Our findings indicate that the clinical outcomes were more favorable in patients operated on at the experienced stage compared to those treated at the beginner stage.
PubMed: 38671734
DOI: 10.3390/bioengineering11040312 -
Medicine Apr 2024To investigate the effects of capacitive and resistive monopolar radiofrequency (CRMF) on the shear elastic modulus of the multifidus and erector spinae muscles in... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To investigate the effects of capacitive and resistive monopolar radiofrequency (CRMF) on the shear elastic modulus of the multifidus and erector spinae muscles in female athletes with low back pain (LBP) and a history of LBP.
DESIGN
Randomized crossover trial.
SETTING
Academic institution.
PARTICIPANTS
Twenty female university athletes with LBP or a history of LBP were included.
INTERVENTIONS
All participants received CRMF, hotpack, and sham (CRMF without power) in a random order on the right side of the lumbar region. More than 2 days were allocated between the experiments to eliminate any residual effects.
MAIN OUTCOME MEASURES
The shear elastic moduli of the right multifidus and erector spinae were evaluated in the prone (rest) position while sitting with 35° trunk flexion (stretched) using shear wave ultrasound imaging equipment. The moduli were measured before, immediately after, and 30 minutes after the intervention.
RESULTS
Repeated-measures 2-way analysis of variance and post hoc analysis showed that the moduli of the CRMF group were significantly lower than those of the sham group in the stretched position immediately after intervention (P = .045). This difference diminished 30 minutes after the intervention (P = .920).
CONCLUSIONS
CRMF can be used to reduce the shear elastic modulus of the multifidus muscle in the short term. Further studies are warranted to determine how to provide longer effects.
TRIAL REGISTRATION
None.
Topics: Humans; Female; Low Back Pain; Cross-Over Studies; Elastic Modulus; Young Adult; Athletes; Lumbosacral Region; Adult; Paraspinal Muscles; Hyperthermia, Induced
PubMed: 38669391
DOI: 10.1097/MD.0000000000038011 -
Journal of Anaesthesiology, Clinical... 2024The use of ultrasound has immensely increased the safety toward regional blocks and central venous access and has been considered as the standard of care for securing...
BACKGROUND AND AIM
The use of ultrasound has immensely increased the safety toward regional blocks and central venous access and has been considered as the standard of care for securing central access. The aim of this study is to estimate the prevalence of occult spinal dysraphism using ultrasound in children less than 2 years of age undergoing elective urogenital or anorectal surgery.
MATERIAL AND METHODS
The lumbosacral region of 159 American Society of Anesthesiologists (ASA) category I/II patients, posted for elective urogenital and anorectal surgery was scanned with ultrasound, prior to giving caudal block.
RESULTS
The prevalence of occult spina bifida was 3% in our study. There was no statistically significant association of cutaneous marker with abnormal scan.
CONCLUSION
Prevalence of occult spina bifida was ten-times higher in our study than in the general population. Perioperative ultrasound screening of the lower spinal anatomy by anesthesiologist done prior to performing neuraxial block is worthwhile in ruling out occult spinal anomalies in high-risk children of occult spinal dysraphism.
PubMed: 38666156
DOI: 10.4103/joacp.joacp_254_22 -
Turkish Neurosurgery 2024To compare the procedural features of transforaminal epidural steroid injection (TFESI) performed using two different needles (Stimuplex® and Quincke) in terms of... (Comparative Study)
Comparative Study
AIM
To compare the procedural features of transforaminal epidural steroid injection (TFESI) performed using two different needles (Stimuplex® and Quincke) in terms of procedure time, exposed radiation dose and adverse effects and complications, thus providing preliminary data to aid needle selection for TFESI.
MATERIAL AND METHODS
Patients who received fluoroscopy-guided single-level lumbosacral TFESI between September 2020 and September 2021 were retrospectively included in this study. The patients were divided into two groups with respect to the needle type used for the procedure ? those treated with a Quincke needle were classified as Group Q and those treated with a Stimuplex® needle comprised Group S. Subsequently, the two groups were compared in terms of their demographic data, procedure time, radiation dose, amount of contrast use, first-hour numeric rating scale (NRS), intravascular flow and complication rates.
RESULTS
The number of patients recruited for Groups Q and S was 65 and 61, respectively. No significant difference was observed between the groups regarding their demographic data, preprocedural NRS scores, procedure time, exposed radiation dose and the amount of contrast dye used. Notably, the first-hour NRS scores were found to be significantly lower in Group S (p=0.040) after the procedure. Moreover, the intravascular contrast spread was significantly different between the two groups (p < 0.05) ? it was encountered during four procedures in Group Q, but was altogether absent in Group S.
CONCLUSION
The Stimuplex® needle may decrease the possibility of inadvertent intravascular leakages during TFESI and may also improve immediate pain scores after the procedure.
Topics: Humans; Male; Injections, Epidural; Female; Middle Aged; Needles; Retrospective Studies; Steroids; Aged; Adult; Fluoroscopy; Lumbosacral Region; Lumbar Vertebrae; Peripheral Nerves
PubMed: 38650563
DOI: 10.5137/1019-5149.JTN.43946-23.4 -
Heliyon Apr 2024The vertebral column represents an essential element for support, mobility, and the protection of the central nervous system. Various pathologies can compromise these...
The vertebral column represents an essential element for support, mobility, and the protection of the central nervous system. Various pathologies can compromise these vital functions, leading to pain and a decrease in the quality of life. Within the scope of this study, a novel redesign of the Intersomatic Cage, traditionally used in the presence of discopathy, was proposed. The adoption of additive manufacturing technology allowed for the creation of highly complex geometries, focusing on the lumbosacral tract, particularly on the L4-L5 and L5-S1 intervertebral discs. In addition to the tensile analysis carried out using Finite Element Analysis (FEA) in static simulations, a parallel study on the range of motion (ROM) of the aforementioned vertebral pairs was conducted. The ROM represents the relative movement range between various vertebral pairs. The introduction of the intersomatic cage between the vertebrae, replacing the pulpy nucleus of the intervertebral disc, could influence the ROM, thus having significant clinical implications. For the analysis, the ligaments were modelled using a 1D approach. Their constraint reaction and deformability upon load application were analysed to better understand the potential biomechanical implications arising from the adoption of the cages. During the FEA simulations, two types of cages were analysed: LLIF for L4-L5 and ALIF for L5-S1, subjecting them to four different loading conditions. The results indicate that the stresses exhibited by cages with a NET structure are generally lower compared to those of traditional cages. This stress reduction in cages with NET structure suggests a more optimal load distribution, but it is essential to assess potential repercussions on the surrounding bone structure.
PubMed: 38617931
DOI: 10.1016/j.heliyon.2024.e28978 -
Journal of Orthopaedic Surgery and... Apr 2024Our study aimed to assess the effectiveness of the simplified S1 vertebral bone quality (VBQ) score in predicting the incidence of proximal junctional kyphosis (PJK)... (Review)
Review
OBJECTIVE
Our study aimed to assess the effectiveness of the simplified S1 vertebral bone quality (VBQ) score in predicting the incidence of proximal junctional kyphosis (PJK) after surgery for degenerative lumbar scoliosis (DLS).
METHODS
We reviewed 122 patients with DLS who underwent posterior lumbar decompression and long-segment fusion surgery in our hospital from January 2016 to December 2020. The patients were classified into PJK group and non-PJK group. S1 VBQ scores are determined by signal intensity measurements taken from the mid-sagittal plane of T1-weighted non-contrast MRI. Logistic regression analysis was used to identify factors associated with PJK. Receiver-operating characteristic curve (ROC) analysis was used to evaluate the value of S1 VBQ score in predicting pedicle PJK after DLS.
RESULTS
122 DLS patients (90 females and 32 males) met the inclusion criteria. In addition, 27 patients (22.13%) had PJK at the time of last follow-up. VBQ was higher in PJK patients than non-PJK patients (3.58 ± 0.67 vs. 3.08 ± 0.54, p < 0.001). Preoperatively, patients in the PJK group had a greater TLK than those in the non-PJK group (20.00 ± 6.22 vs. 16.86 ± 5.38, p = 0.011). After surgery, patients in the PJK group had greater TLK (p < 0.001) and PJA (p < 0.001) compared with the non-PJK group. At final FU, patients in the PJK group had greater TK (p = 0.002), TLK (p < 0.001), SVA (p < 0.001), and PJA (p < 0.001) than patients in the non-PJK group (Table 4). In multivariate logistic regression analysis, higher VBQ score (OR 4.565, 95% CI 1.43-14.568, p = 0.010), advanced age (OR 1.119, 95% CI 1.021-1.227, p = 0.016), and larger TLK (OR 1.191, 95% CI 1.041-1.362, p = 0.011) were significant predictors of postoperative PJK in patients with DLS (Table 6). A statistically significant positive correlation existed between VBQ score and PJA change (r = 0.370, p < 0.001). We created ROC curves for VBQ scores as predictors of PJK with a diagnostic accuracy of 72.1% (95% CI 60.15-82.9%.The ideal limit for the VBQ score was 3.205 (sensitivity: 77.8%, specificity: 81.4%).
CONCLUSION
To the best of our knowledge, this is the first study to evaluate the effectiveness of the S1 VBQ score in predicting postoperative PJK in DLS. Our study included major risk factors and found that S1 VBQ score was a significant predictor of PJK in patients undergoing DLS surgery. The higher the S1 VBQ score, the higher the probability of PJK.
Topics: Female; Male; Humans; Scoliosis; Spine; Kyphosis; Hospitals; Lumbosacral Region
PubMed: 38615068
DOI: 10.1186/s13018-024-04722-y -
BMC Musculoskeletal Disorders Apr 2024The aim of this study was to evaluate the psychological distress pre-operatively, at 3, 6, and 12 months in patients who underwent lumbar spine fusion surgery.
BACKGROUND
The aim of this study was to evaluate the psychological distress pre-operatively, at 3, 6, and 12 months in patients who underwent lumbar spine fusion surgery.
METHODS
A total of 440 patients received instrumented lumbar spine fusion were enrolled. Psychological distress was evaluated using the Modified Somatic Perception Questionnaire (MSPQ) and the Modified Zung Depressive Index (ZDI). The results of lumbar fusion surgery were evaluated using the Oswestry Disability Index (ODI), the Japanese Orthopedic Association (JOA-29), and the visual analog scale (VAS).
RESULTS
Psychological distress was reported among 23% of patients and 7, 5.5, and 4.0% of the patients preoperatively, at 3, 6, and 12 months after lumbar surgery, respectively. The mean MSPQ score decreased from 8.78 (before surgery) to 4.30, 3.52, and 3.43 at 3, 6 and 12 months in after surgery, respectively, in patients with psychological distress patients (p < 0.001). The mean ZDI score decreased from 17.78 to 12.48, 10.35, and 9.61 (p < 0.001). The mean ODI score decreased from 22.91 to 11.78, 10.13, and 9.96 (P < 0.001). The mean JOA score increased from 13.65 to 22.30, 23.43, and 23.61 (P < 0.001). The mean low back pain (LBP) VAS score decreased from 4.48 to 1.96, 1.52, and 1.51 (P < 0.001); moreover, the mean leg pain (LP) VAS score decreased from 5.30 to 1.30, 1.04, and 1.03 (P < 0.001).
CONCLUSIONS
Patients with psychological distress may experience surgical intervention benefits equal to those of ordinary patients. Moreover, reduced pain and disability after surgical intervention may also alleviate psychological distress. Hence, we highly recommend that patients with psychological distress undergo surgical intervention as normal patients do, but appropriate screening measures and interventions are necessary.
Topics: Humans; Spinal Fusion; Lumbosacral Region; Neurosurgical Procedures; Pain; Psychological Distress
PubMed: 38614982
DOI: 10.1186/s12891-024-07364-7 -
Sensors (Basel, Switzerland) Mar 2024Running is one of the most popular sports practiced today and biomechanical variables are fundamental to understanding it. The main objectives of this study are to...
Running is one of the most popular sports practiced today and biomechanical variables are fundamental to understanding it. The main objectives of this study are to describe kinetic, kinematic, and spatiotemporal variables measured using four inertial measurement units (IMUs) in runners during treadmill running, investigate the relationships between these variables, and describe differences associated with different data sampling and averaging strategies. A total of 22 healthy recreational runners (M age = 28 ± 5.57 yrs) participated in treadmill measurements, running at their preferred speed (M = 10.1 ± 1.9 km/h) with a set-up of four IMUs placed on tibias and the lumbar area. Raw data was processed and analysed over selections spanning 30 s, 30 steps and 1 step. Very strong positive associations were obtained between the same family variables in all selections. The temporal variables were inversely associated with the step rate variable in the selection of 30 s and 30 steps of data. There were moderate associations between kinetic (forces) and kinematic (displacement) variables. There were no significant differences between the biomechanics variables in any selection. Our results suggest that a 4-IMU set-up, as presented in this study, is a viable approach for parameterization of the biomechanical variables in running, and also that there are no significant differences in the biomechanical variables studied independently, if we select data from 30 s, 30 steps or 1 step for processing and analysis. These results can assist in the methodological aspects of protocol design in future running research.
Topics: Biomechanical Phenomena; Health Status; Kinetics; Lumbosacral Region; Running
PubMed: 38610402
DOI: 10.3390/s24072191