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Objective: This study analysed the presence and absence of electromyographic silence during the holding phase of the flexion-relaxation of the trunk. Methodology: The electrical activity of two back muscles (i.e., longissimus and multifidus) of 10 male workers in the maintenance sector, all younger than 65, was recorded when they performed an unloaded anterior flexion of the trunk for 15 seconds. The risk of suffering from low back pain was evaluated based on the calculated flexion-relaxation ratios. Results: In the sample, the average FRRs of the longissimus and multifidus muscles were 6.47 ± 4.21 and 7.99 ± 4.71, respectively. In addition, 20% of the subjects presented values under 2.98 in the longissimus; and 40%, values under 7.21 in the multifidus—which indicates an absence of silences and possible pain. The average flexion velocity was 103.67 ± 15.56°/s; the average relaxation velocity, 98.968 ± 19.11°/s; and the average flexion angle, 106.94 ± 12.60°. Conclusion: The results of this study demonstrate that, in the long term, maintenance and general service workers may suffer from chronic low back discomfort or pain as a consequence of their daily duties

Introduction: Transcutaneous electrical nerve stimulation (TENS) is commonly used for pain management. Recent studies have shown that TENS can improve the condition of low back pain by influencing the elastic coefficient of the lumbar fascia and the balance status; however, the effect of TENS on the lumbar fascia of healthy people has not been investigated. Accordingly, this study examines the effect of TENS on the lumbar fascia of healthy people. Materials and Methods: A total of 60 healthy participants in two groups, underwent 10 sessions of conventional TENS intervention. The first group (intervention group) received TENS with an intensity at the tolerance level, and the second group (control group) received sham TENS. Ultrasonography and a spinal mouse device were assessed lumbar fascia thickness and lumbar curvature before and after the TENS. Results: Significant changes were observed after TENS in the intervention group in reducing the lumbar fascia thickness (P=0.006) and increasing the lumbar curvature (P=0.000). Between-group changes after the intervention sessions indicated a significant difference between the lumbar fascia thickness and curvature (P≤0.003). Conclusion: TENS in healthy people can lead to a decrease in the thickness of the lumbar fascia and improve lumbar curvature. Also, a strong correlation was found between lumbar fascia thickness reduction and increased lumbar curvature. [ABSTRACT FROM AUTHOR]

Introduction: Transcutaneous electrical nerve stimulation (TENS) is commonly used for pain management. Recent studies have shown that TENS can improve the condition of low back pain by influencing the elastic coefficient of the lumbar fascia and the balance status; however, the effect of TENS on the lumbar fascia of healthy people has not been investigated. Accordingly, this study examines the effect of TENS on the lumbar fascia of healthy people. Materials and Methods: A total of 60 healthy participants in two groups, underwent 10 sessions of conventional TENS intervention. The first group (intervention group) received TENS with an intensity at the tolerance level, and the second group (control group) received sham TENS. Ultrasonography and a spinal mouse device were assessed lumbar fascia thickness and lumbar curvature before and after the TENS. Results: Significant changes were observed after TENS in the intervention group in reducing the lumbar fascia thickness (P=0.006) and increasing the lumbar curvature (P=0.000). Between-group changes after the intervention sessions indicated a significant difference between the lumbar fascia thickness and curvature (P≤0.003). Conclusion: TENS in healthy people can lead to a decrease in the thickness of the lumbar fascia and improve lumbar curvature. Also, a strong correlation was found between lumbar fascia thickness reduction and increased lumbar curvature.

Introduction. Individuals working in the nursing profession are particularly prone to experiencing spinal discomfort. This is due to the nature of their work, which involves lifting and carrying heavy loads, as well as working in constrained positions. Furthermore, nurses are also exposed to stress and excessive mental health strain. All of these factors can contribute to the occurrence of overloads and injuries to the spine. Aim. The aim of the study was to analyze the frequency of spinal pain symptoms among nursing staff. Material and Methods. The study group consisted of 155 individuals actively practicing the nursing profession. The Polish version of the Revised Oswestry Low Back Pain Disability Scale (OLBPDS-PL) and own questions were used to conduct the study. Results. The frequency of spinal pain symptoms among nursing staff was 96.64%. 55.6% of the respondents reported mild disability, while 16.6% reported severe disability. A correlation was established between gender (p=0.026), the number of hours spent at work (p=0.049), BMI index (p=0.020), and the frequency of spinal pain symptoms. Age was borderline to statistically significant (0.050). Conclusions. Spinal pain symptoms affect a significant portion of the studied group. Lower back pain worsens the daily functioning of nurses, primarily in terms of pain intensity, lifting objects, standing, and social life. Mild disability was observed in over half of the respondents with lower back pain symptoms. (JNNN 2024;13(1):3–8)

Study Design Retrospective single-center study. Purpose This study aims to evaluate perioperative and intermediate-term clinical outcomes of patients undergoing different lumbar fusion techniques. Overview of Literature Various open and minimally invasive techniques for lumbar fusion are available, but previous studies comparing lumbar fusion techniques have heterogeneous data, making interpretation challenging. Methods Between 2011 and 2018, data from 447 consecutive patients undergoing one/two-level lumbar fusion were analyzed. Posterior lumbar interbody fusion (PLIF) with bilateral muscle strip or Wiltse approach, open transforaminal lumbar interbody fusion (TLIF) and minimally invasive TLIF, and posterolateral fusion only were among the surgical techniques used. Core outcomes measure index (COMI) questionnaires were distributed before surgery and at 3 months, 1 year, and 2 years postoperatively to establish patient self-reported outcome measures. Demographic data (age, gender, and body mass index [BMI]) for each patient were also collected in addition to surgical indication, previous operative history, perioperative outcomes, and complications, and whether later revision surgery was required. Pearson’s chi-square test, Kruskal-Wallis test, repeated measure mixed-effects models, and ordinal logistic regression were used for statistical analysis. Results Postoperative COMI scores improved across all procedures compared with pre-surgery (p

Objective: This study analysed the presence and absence of electromyographic silence during the holding phase of the flexion-relaxation of the trunk. Methodology: The electrical activity of two back muscles (i.e., longissimus and multifidus) of 10 male workers in the maintenance sector, all younger than 65, was recorded when they performed an unloaded anterior flexion of the trunk for 15 seconds. The risk of suffering from low back pain was evaluated based on the calculated flexion-relaxation ratios. Results: In the sample, the average FRRs of the longissimus and multifidus muscles were 6.47 ± 4.21 and 7.99 ± 4.71, respectively. In addition, 20% of the subjects presented values under 2.98 in the longissimus; and 40%, values under 7.21 in the multifidus--which indicates an absence of silences and possible pain. The average flexion velocity was 103.67 ± 15.56°/s; the average relaxation velocity, 98.968 ± 19.11°/s; and the average flexion angle, 106.94 ± 12.60°. Conclusion: The results of this study demonstrate that, in the long term, maintenance and general service workers may suffer from chronic low back discomfort or pain as a consequence of their daily duties. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal disorders related to work are among the most common occupational injuries. Back pain is the most common musculoskeletal disorder among office workers and computer users. The present study was conducted to investigate the effect of 12 weeks of Williams corrective exercises on the reduction of back pain in the health workers of two cities of Selseleh (Aleshtar) and Noorabad, Iran. Methods: The present study was an interventional and cross-sectional study conducted on all the health workers of Selseleh and Noorabad cities, using census and cluster sampling methods during the year 2021. Among the 196 health workers in these two cities, 36 people from Selseleh City and 60 people from Noorabad City who had back pain were identified using the Nordic questionnaire. After homogenization in terms of age, gender, body mass index (BMI), and height, people were divided into two control and intervention groups, and their working posture was evaluated using the Rapid Upper Limb Assessment (RULA) method. After the training class, the health workers in the intervention group were asked to perform Williams partial sit up corrective movements, including stretching the back muscles of the thigh, tilting the pelvis, two knees to the chest, partitioning, circular rings, and quadriceps stretching, for 12 weeks. Finally, the data obtained from the questionnaires were collected and statistically analyzed using SPSS software. Findings: In total, 25 men (37.4%) and 47 women (65.3%) participated in the study, and the most significant number of surveyed people (62.5%) had a diploma. Investigations showed that the RULA score after the intervention was significantly lower in the intervention group than in the control group. Before performing the corrective movements, the score obtained by the RULA method for both the intervention and control groups showed level 2, but after performing the exercises, 13 people (36.1%) out of 36 people in the intervention group improved and were placed at level 1, and the musculoskeletal complaints of 11 people (30.6%) also improved. Conclusion: Considering the development of the mechanization of physical jobs, the advancement of technology, and the increase in the use of computers, as well as considering the importance of the health of employees, including health workers, it is necessary to take a step by adopting a suitable and effective strategy in the offices in order to improve and prevent the occurrence of such disorders.

Study Design: Retrospective single-center study. Purpose: This study aims to evaluate perioperative and intermediate-term clinical outcomes of patients undergoing different lumbar fusion techniques. Overview of Literature: Various open and minimally invasive techniques for lumbar fusion are available, but previous studies comparing lumbar fusion techniques have heterogeneous data, making interpretation challenging. Methods: Between 2011 and 2018, data from 447 consecutive patients undergoing one/two-level lumbar fusion were analyzed. Posterior lumbar interbody fusion (PLIF) with bilateral muscle strip or Wiltse approach, open transforaminal lumbar interbody fusion (TLIF) and minimally invasive TLIF, and posterolateral fusion only were among the surgical techniques used. Core outcomes measure index (COMI) questionnaires were distributed before surgery and at 3 months, 1 year, and 2 years postoperatively to establish patient selfreported outcome measures. Demographic data (age, gender, and body mass index [BMI]) for each patient were also collected in addition to surgical indication, previous operative history, perioperative outcomes, and complications, and whether later revision surgery was required. Pearson's chi-square test, Kruskal-Wallis test, repeated measure mixed-effects models, and ordinal logistic regression were used for statistical analysis. Results: Postoperative COMI scores improved across all procedures compared with pre-surgery ( p<0.001). There was no significant difference between different postoperative COMI scores. Significant predictors of higher postoperative COMI score included higher pretreatment COMI score ( p≤0.001), previous surgery ( p≤0.04), younger age ( p≤0.05), higher BMI ( p≤0.005), and the indications of lytic spondylolisthesis ( p=0.02) and degenerative disc disease ( p<0.001). Patients undergoing minimally invasive TLIF had a significantly shorter post-surgery stay than patients undergoing open PLIF (Kruskal-Wallis test, p=0.03). Conclusions: At 2 years postoperatively, there was no significant difference in clinical outcomes between open and minimally invasive techniques. These findings suggest that the main determinant of surgical approach should be surgeon preference and training. [ABSTRACT FROM AUTHOR]

Gold thread therapy (GTT) continuously stimulates acupoints and is used to treat chronic conditions/diseases such as chronic lumbar pain. During the procedure gold thread is embedded into the skin and although gold thread is medically pure, GTT is an irreversible treatment where there is limited evidence on its safety. Here, we report a case of a 79-year-old woman being treated for low back pain who developed side effects following moving cupping therapy at a site of GTT (performed in the 1970s). Adverse reactions causing radiating pain persisted more than at least 9 days following moving cupping therapy. The symptoms of pain were evaluated using the numerical rating scale, and changes in tenderness and the state of bruising was recorded. Low back pain improved but the radiating low leg pain did not improve. This case highlights the need for caution when performing moving cupping therapy where GTT has been previously performed.

Selective Nerve Root Block (SNRB) is a precise local injection technique that can be utilised to target a particular inflamed nerve root causing lumbar radiculopathy for both diagnostic and therapeutic purposes. Usually, for SNRB to be therapeutic, a combination of a local anaesthetic agent and a steroid is injected under imaging guidance, whereas for diagnostic purposes, just the local anaesthetic agent is injected. While the ideal treatment strategy is to relieve the nerve root from its compressing pathology, local injection of steroids targeted at the affected nerve root can also be attempted to reduce inflammation and thus achieve pain relief. Although the general principle for administering an SNRB remains largely the same across the field, there are differences in techniques depending on the region and level of the spine that is targeted. Moreover, drug combinations utilised by clinicians vary based on preference. The proven benefits of SNRBs largely outweigh their risks, and the procedure is deemed safe and well tolerated in a majority of patients. In this narrative, we explore the existing literature and seek to provide a comprehensive understanding of SNRB as a treatment for lumbar radiculopathy, its indications, techniques, outcomes, and complications.

ABSTRACT BACKGROUND: The Pregnancy Mobility Index (PMI) was developed to assess mobility in pregnant women in the Netherlands. At present, no similar questionnaire is available in Brazil. OBJECTIVE: The present study aimed to translate, cross-culturally adapt, and evaluate the psychometric properties of a Brazilian PMI. DESIGN AND SETTING: The present study was a validation study conducted at the Universidade Federal do Paraná and a public maternity ward in Curitiba, Brazil. METHODS: Text translation and cross-cultural adaptation followed international guidelines. Construct validity, internal consistency, and inter- and intra-rater reliability tests included 97 women. The Pelvic Girdle Questionnaire, Multidimensional Pain Evaluation Scale, Schober’s test, and lumbar spine range of motion assessment were administered on the first day. Intra-rater reliability (n = 19) was measured after 15 days. Exploratory factor analysis was performed, and the correlation matrix was analyzed using Pearson’s coefficient. RESULTS: Pregnant women (88%) understood the cultural adaptation process. The internal consistency was high (Cronbach’s alpha > 0.90), construct validity was moderate, with significant correlation between lumbar spine range of motion (r = 0.283–0.369) and Schober’s test (r = -0.314), and high correlation between the Multidimensional Pain Evaluation Scale (r = -0.650 and -0.499) and Pelvic Girdle Questionnaire (r = -0.737). Intra- and inter-rater reliabilities were excellent (intraclass correlation coefficient = 0.932 and 0.990, respectively). CONCLUSION: The Brazilian version of the PMI was successfully translated with excellent reliability and moderate-to-high construct validity. It is an important tool for assessing mobility in pregnant women. CLINICAL TRIAL: RBR-789tps (Validation study), https://ensaiosclinicos.gov.br/rg/RBR-789tps.

Adrenal Gland Cysts are rare among all the pathologic cysts that occur in human beings; the pseudo-cyst variety even rarer. Adrenal pseudo-cysts are asymptomatic, non-functional, small, and incidentally discovered disease entities. Their clinical presentation is usually the result of their mass effects. Thanks to the advanced diagnostic technology, more such cases are being discovered timely and managed surgically, before life-threatening complications occur. Open surgical treatment remains the treatment of choice for giant cysts. Keywords: Adrenal Gland Cyst, Pseudo-, Lumbar region.

Drains for surgical wound management are frequently used in spine surgery. They are often used to decrease the incidence of postoperative hematoma and decrease wound tension. No conclusive evidence in the literature supports using drains to avoid complications in degenerative lumbar spine surgery. We aimed to evaluate wound drains in patients with lumbar arthrodesis for degenerative disorders based on clinical outcomes, complications, hematocrit, and length of stay. A multicenter randomized prospective controlled clinical trial. We enrolled surgical candidates for posterior lumbar decompression and fusion surgery for degenerative disorders from October 2019 to August 2021. Patients were randomized into the drain or nondrain group at nine hospitals. The inclusion criteria were as follows: patients aged 40 to 80 years with lumbar and radicular pain, lumbar degenerative disorder, and primary surgery up to three levels. The exclusion criteria were bleeding abnormalities, bleeding >2,500 mL and dural tears. Preoperative data including Oswestry disability index (ODI), SF-36, lumbar and lower extremity visual analog scale (VAS), body mass index (BMI), hematocrit, and temperature were recorded. Surgical parameters, including surgical time, complications, estimated blood loss (EBL), postoperative temperature and hematocrit (days 1 and 4), dressing saturation, and length of hospital stay (LOS), were registered. The two groups were assessed preoperatively, perioperatively and at the 1-month follow-up. A REDCap database was used for registration. Data analysis was performed using classical statistics. One hundred one patients were enrolled using the Redcap database, and 93 patients were evaluated at the final follow-up. Forty-five patients were randomized to the drain group, and 48 were randomized to the nondrain group. The preoperative characteristics were equivalent in both groups: demographic aspects, pain, ODI, SF-36, BMI, hematocrit, and spine pathology. Surgical time, EBL and complications were similar, with no difference between the groups. No difference was found between BMI and complications. No difference was observed in dressing saturation or postoperative temperature between the groups. The postoperative day 4 hematocrit was higher in the nondrain group [36.4% (32–39)] than in the drain group [34% (29.7–37.6)] without statistically differences (p=.054). The LOS was higher in the drain group [4 (3–5) days] than in the nondrain group [3 (2–4) days] (p=.007). The quality-of-life score, SF-36, was higher in the nondrain group [67.9 (53.6–79.2)] than in the drain group [56.7 (49.1–66)] (p=.043). Nondrain patients presented shorter LOS and better outcomes, with similar complication rates. No difference was found between BMI and complications. Based on this study, in patients undergoing primary posterior spinal decompression and fusion up to three levels for degenerative lumbar disorders, we do not recommend the use of postoperative drains. [ABSTRACT FROM AUTHOR]

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Simple Summary: Conventional diagnostic techniques cannot always provide a diagnosis for horses with back pain. A better visualization of the vertebral morphologic details can be achieved by using advanced diagnostic imaging tools. For this reason, this study presented a detailed post-mortem computed tomographic description of the anatomical variations and acquired osseous pathological changes in the equine caudal lumbar region that have never been reported. The authors hypothesized that body weight, age, previous use, and some anatomical variations might be correlated with the presence and severity of the lesions. The results partially supported the initial hypotheses because the concomitant presence of anatomical variations and acquired osseous pathological changes at the same level, and the correlation between age and the presence of some degenerative pathologies were observed. Furthermore, this study provided additional tomographic information on bone features in both pathological and non-pathological specimens. However, other future studies are needed to correlate the clinical significance of the anatomical variations and acquired osseous pathologies of the equine lumbar vertebrae. The radiographic, ultrasonographic, and scintigraphic findings of horses with thoracolumbosacral pain have been previously reported. In this study, the computed tomographic appearance of anatomical variations and pathological changes of the equine caudal lumbar region through a post-mortem examination were investigated. A total of 40 horses that had died or were submitted for euthanasia, for reasons unrelated to the study, were included in the study. From all the specimens, the modified vertebral system was adopted to evaluate and describe the four most caudal lumbar vertebrae, which were numbered from a caudal reference point (lumbosacral junction), with the segment number designated within parentheses (i.e., L(i)-L(iv)). Contact of the spinous processes was detected in 21 specimens (54%) and fusion in 6 specimens (15%). Lumbar spondylosis was seen in 17 specimens (42.5%), more commonly on the lateral aspect or on both ventral and lateral aspects in 12 specimens (71%). The presence of spondylosis was found more commonly in older horses (p < 0.001). There was no difference in bony density in specimens with spondylosis or spinous processes contact compared to specimens without. The highest prevalence of bony changes was found at L(ii)-L(i) intertransverse joints in 28 specimens (97%) on the left and in 22 specimens (96%) on the right side. Spondylolisthesis and partial fusion of the L(ii)-L(i) vertebral disc were found in association with degenerative pathologies. This study showed a high frequency of several anatomical variations and acquired osseous pathological changes in the most caudal lumbar vertebrae via a CT examination. [ABSTRACT FROM AUTHOR]

Retroperitoneal Cysts (RPC) are uncommon, with an estimated incidence of 1 in 5,750 to 1 in 250,000. A 26-year-old woman presented with dull aching, non-radiating pain in the upper abdomen for the past two months, with no aggravating or relieving factors. On clinical examination of the abdomen, a grossly visible mass measuring approximately 10x10 cm with a smooth surface, firm consistency, and well-defined borders was observed in the left lumbar and iliac region. Contrast-Enhanced Computed Tomography (CECT) of the abdomen and pelvis revealed a well-circumscribed cystic lesion measuring 9.3x9.5x5.5 cm in the left lumbar region near the tail of the pancreas. The pancreas appeared normal with no surrounding fat stranding or inflammatory changes. Peripheral enhancement and peripheral wall calcification were observed. The patient underwent laparotomy and cyst excision. Intraoperatively, the cyst was found to arise from the retroperitoneum located in the lesser sac. It was dissected out from the tail of the pancreas, and no obvious communication with the pancreas was observed. The cyst was excised completely. Histopathological examination revealed a cyst with absent endothelium, suggestive of a pseudocyst. Previous literature reports indicate that RPCs are very rare and are often discovered incidentally. Patients may be asymptomatic or present with vague symptoms. Imaging can help diagnose these lesions, but surgery is crucial in confirming the diagnosis.

Objective Oblique anterior to psoas (ATP) interbody lumbar fusion is associated with advantages such as sufficient indirect decompression and restoration of lordosis. Therefore, a comprehensive preoperative assessment that includes the location of entry into the disc space, a feasible trajectory to complete the intervertebral space procedure, and the possible retraction of the psoas muscle is necessary to correctly and safely perform the technique. Methods From January 2019 to January 2020, 160 lumbar CT scans were evaluated. Only 124 images from the L2-L3, L3-L4, and L4-L5 levels met the inclusion criteria. The length of the anterior vertebral line (AVL) and the middle-third of the disc in the anteroposterior axis were measured to localize the entry point (EP). The distance between the anterior arterial vessel (AV) and the EP was also measured. The trajectory commonly used to set the surgical instruments into the disc space was called α, and a new proposed trajectory termed β was calculated. The psoas cross-sectional area anterior to the β angle trajectory was measured to determine any possible retraction using this parameter. Results The EP-AVL distances were L2-L3 11.49 ± 0.89 mm, L3-L4 11.54 ± 0.88 mm, and L4-L5 11.57 ± 0.87 mm. The EP-AV lengths were 17.64 ± 5.62 mm, 19.36 ± 5.49 mm, and 16.48 ± 6.47 mm at L2-L3, L3-L4, and L4-L5, respectively. The average α and β trajectory angles reported were 39.91º and 14.48º, respectively. Psoas muscle retraction was primarily noted at the L4-L5 level. Conclusion This article's proposed parameters represent a routine preoperative safety assessment in patients previously selected for oblique ATP lumbar interbody fusion.

Background and Objective: Back pain is a common orthopedic disease that affects up to 80% of the population at some point in life. Brace is one of the tools that used to reduce pain. The relationship between brace application and gait parameters in people with low back pain is not well understood. This study was done to determine the effects of simple and sensor thoracolumbosacral braces on gait kinetics in patients with low back pain. Methods: This quasi-experimental study was performed on 15 men and women with low back pain in the biomechanics laboratory of Mohaghegh Ardabili University Health Center in nort-west of Iran during 2020. Each participant performed three gait conditions including without brace, with sensory brace and with simple brace. Ground reaction forces were recorded and compared by a force plate while walking. Results: The average walking speed during no brace, simple brace and sensor braces were not significant different. Also, results did not demonstrate any significant effect of simple or sensor braces on ground reaction force amplitudes, their time to peak, and free moment values. Conclusion: Simple and sensory thoracolumbosacral brace did not effect on gait kinetics in low back patients.

Background and Aim: This study aims to evaluate the frequency of adjacent segment disease (ASD) and its risk factors following posterior decompression and fusion in lumbar degenerative disorders. Methods and Materials/Patients: This retrospective cohort study was performed by reviewing the records of patients with spinal degeneration disorders who underwent lumbar fusion surgery and needed reoperation from 2013 to 2019. The participants were divided into two groups, including patients with ASD and non-ASD patients, and were compared in terms of age, sex, BMI, smoking, fusion level, surgical indications, follow-up times, laminectomy, cross-link device usage, imaging findings, fusion terminating in L1, L5 and S1, and reoperation. Results: Out of a total of 277 candidates, 181 met the inclusion criteria. In terms of gender distribution, 43.3% of the participants were male and 56.7% were female. The median age was 54 years in the ASD group and 48 years in the non-ASD group. The median follow-up of the patients was six years in the ASD group and five years in the non-ASD group. Forty patients (22.1%) developed ASD during this period. The final analysis showed a significant relationship between age, sex, indication for reoperation, repeated surgery, laminectomy, cross-link device use, imaging findings, and fusion terminating in L1. Conclusion: High body mass index, aging, lumbar spinal canal stenosis, reoperation, laminectomy at the upper fusion unit, cross-link device use, lumbar canal stenosis in imaging, and fusion to L1 vertebrae are considered risk factors for ASD. [ABSTRACT FROM AUTHOR]

Background and Aim: Lumbar spine posterior stabilization surgery is based on the formation of bone structures around the device placement. However, if these bone structures are not formed well, the conditions for pseudoarthrodesis are provided. In recent years, the use of platelet-rich plasma (PRP) as an induction of bone formation after spinal stabilization has received attention, but its results have been different and sometimes controversial. This study was conducted to accurately evaluate the effect of this method on arthrodesis after lumbar spine posterior stabilization surgery. Methods and Materials/Patients: Twenty patients under the age of 70 years who were candidates for posterior spinal stabilization surgery were selected, and on the day of surgery, PRP was prepared from their venous blood, and at the end of the surgery, a combination of PRP and allograft bone was used on one side of the spine, and a combination of normal saline and allograft bone was used on the other side for arthrodesis. Then, the arthrodesis in the patients was evaluated with a computerized tomography (CT) scan in the third, sixth, and twelfth months after the operation by two radiologists based on the Hounsfield index. Results: In all 20 patients, the arthrodesis was significant during the third, sixth, and twelfth months in the intervention side and in the control side and had a decreasing trend (P<0.001). In the comparison of the arthrodesis rate in the third and twelfth months after the operation, no significant difference was observed between the intervention and control groups (P=0.120 and P=0.405, respectively). In the sixth month, the rate of arthrodesis between the intervention and control groups was borderline statistically significant (P=0.061). Conclusion: The use of PRP in the stabilization of the lumbar spine does not affect the increasing rate of spinal arthrodesis, and it may only accelerate the rate of arthrodesis in the sixth month. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Sciatica Frequency Index (SFI) and Sciatica Bothersomeness Index (SBI) are two separate indices scored for both the bothersomeness and frequency of radiating symptoms. There is no Turkish scale used specifically for sciatica. OBJECTIVE: We aimed to translate SBI and SBI in Turkish and investigate the reliability and validity of these indices. METHODS: A total of 80 patients with lumbar disc herniation (LDH) were prospectively included. Construct validity was assessed by comparing the SBI and SFI with subscales of Short Form 36 (SF-36), back and leg Numeric Rating Scale (NRS) and Roland Morris Disability Questionnaire (RMDQ). Reliability was assessed by internal consistency (Cronbach's alpha) and test-retest reliability. RESULTS: A weak correlation was found between SBI/SFI, back NRS and SF-36 subgroups while a moderate correlation was found between SBI/SFI, RMDQ and leg NRS. The SBI and SFI had high internal consistency measured by Cronbach's alpha (0.76 and 0.73). Test-retest reliability of the SBI and SFI were 0.95 (95% CI: 0.92-0.97) and 0.95 (95% CI: 0.92-0.97) respectively, indicating excellent reliability. CONCLUSION: The Turkish versions of the SFI/SBI are a valid and reliable tool supporting their usability in patients with LDH-induced sciatica. [ABSTRACT FROM AUTHOR]

Lumbar spinal stenosis (LSS) is a common degenerative spinal condition that can have unpredictable improvement and worsening of symptoms which include low back pain, radiating pain, claudication, and degenerative lumbar scoliosis affecting quality of life. In this study, thread embedding acupuncture (TEA) was used as a conservative treatment for LSS in combination with complex Korean medicine treatments (acupuncture, herbal medicines, and physical therapy). The treatment was evaluated using the numerical rating scale, walking distance and duration, and inclination of radiological lumbar scoliosis according to antalgic posture. TEA was performed 27 times between June 8, 2020, and March 16, 2021. The patient showed improvement in numerical rating scale score from 7 to 2, pain-free walking distance from 10 m to 900 m, and scoliosis inclination following treatment. The findings of this study suggest that TEA may be helpful in the treatment of LSS.

Background and Aim: Lumbar spine posterior stabilization surgery is based on the formation of bone structures around the device placement. However, if these bone structures are not formed well, the conditions for pseudoarthrodesis are provided. In recent years, the use of platelet-rich plasma (PRP) as an induction of bone formation after spinal stabilization has received attention, but its results have been different and sometimes controversial. This study was conducted to accurately evaluate the effect of this method on arthrodesis after lumbar spine posterior stabilization surgery. Methods and Materials/Patients: Twenty patients under the age of 70 years who were candidates for posterior spinal stabilization surgery were selected, and on the day of surgery, PRP was prepared from their venous blood, and at the end of the surgery, a combination of PRP and allograft bone was used on one side of the spine, and a combination of normal saline and allograft bone was used on the other side for arthrodesis. Then, the arthrodesis in the patients was evaluated with a computerized tomography (CT) scan in the third, sixth, and twelfth months after the operation by two radiologists based on the Hounsfield index. Results: In all 20 patients, the arthrodesis was significant during the third, sixth, and twelfth months in the intervention side and in the control side and had a decreasing trend (P

BACKGROUND: The multifidus muscle is important in spine stabilization. Atrophy of the multifidus muscle has been associated with low back pain. OBJECTIVE: To examine multifidus muscle cross-sectional area (CSA) adaptations over two volleyball seasons and one off-season in volleyball athletes experiencing low back pain or no low back pain. METHODS: Twelve female NCAA division 1 volleyball athletes participated. Athletes were placed into a low back pain or no low back pain group. Athlete's multifidus was imaged and measured using ultrasound at four time points across seasons. Imaging time points were before season one, following season one, following off-season, and following season two. A single level mixed-model analysis of variance was used for all analyses. A Tukey HSD post hoc test was used to determine differences between and within the low back pain and the no low back pain groups. RESULTS: Following off-season training the pain group had clinically significant smaller multifidus CSA at the L4 (- 2.36 cm 2 difference or 17.5%) and L5 (- 2.40 cm 2 or 12.5%) levels. Non-significant (p > 0.05) decreases in multifidus CSA were seen in both groups following season one and two. Athletes with pain had decreased multifidus CSA at the L4 and L5 vertebral levels at all time points which was non-significant (p > 0.05). CONCLUSIONS: Clinically significant decreases in multifidus CSA occurred in female volleyball athletes with low back pain at the L4 and L5 level following off-season training. Volleyball athletes with pain had smaller multifidus CSA averages at all time points measured of the two year period. [ABSTRACT FROM AUTHOR]

The ultrasound-guided erector spinae plane (ESP) block is a novel interfascial plane block technique providing analgesic effects in different localizations of the body, in accordance with the level of administration. Although ESP block is usually performed in the thoracic region in pediatric patients, it is possible to achieve ESP block in the lumbar region as well. Postoperative pain management is essential in patients undergoing operative hip treatment, one of the most common procedures in pediatric orthopedic surgery. We report on a case of effective intraoperative analgesia achieved by ultrasound-guided lumbar ESP block and another case of effective intra- and postoperative analgesia accomplished with perineural catheter placement in addition to lumbar ESP block, both performed in children surgically treated for developmental hip disorders.

Background and Objective: Back pain is a common orthopedic disease that affects up to 80% of the population at some point in life. Brace is one of the tools that used to reduce pain. The relationship between brace application and gait parameters in people with low back pain is not well understood. This study was done to determine the effects of simple and sensor thoracolumbosacral braces on gait kinetics in patients with low back pain. Methods: This quasi-experimental study was performed on 15 men and women with low back pain in the biomechanics laboratory of Mohaghegh Ardabili University Health Center in nort-west of Iran during 2020. Each participant performed three gait conditions including without brace, with sensory brace and with simple brace. Ground reaction forces were recorded and compared by a force plate while walking. Results: The average walking speed during no brace, simple brace and sensor braces were not significant different. Also, results did not demonstrate any significant effect of simple or sensor braces on ground reaction force amplitudes, their time to peak, and free moment values. Conclusion: Simple and sensory thoracolumbosacral brace did not effect on gait kinetics in low back patients. [ABSTRACT FROM AUTHOR]

Study Design Prospective, comparative. Purpose To compare the histopathological and electron microscopic changes in the ligamentum flavum (LF) between degenerative lumbar canal stenosis (LCS) and lumbar disk herniation (LDH). Overview of Literature The LF has been implicated as a key structure in the pathogenesis of LCS. With aging, the LF undergoes morphological changes–a decrease in the elastic component and an increase in the collagen component, in addition to other focal changes. By comparing the histopathological and electron microscopic picture of the LF in elderly patients with LCS with that in young patients with LDH, the role of this ligament in the pathogenesis of LCS may be clarified. Methods Forty patients were prospectively recruited and divided into two groups: group 1 included 20 patients with degenerative LCS aged >55 years and group 2 included patients with LDH aged

Study Design Retrospective cohort study. Purpose To determine the effects of massive weight loss on perioperative complications after lumbar fusion surgery (LFS). Overview of Literature Patients who are obese are more likely to experience low back pain, which would require LFS. Nonetheless, they have a higher risk of perioperative complication development compared with individuals who are not obese. Methods Patients who underwent LFS at hospitals that participated in the National Surgical Quality Improvement Program database within the United States between 2005 and 2015. Outcomes included 30-day medical complications, surgical complications, and length of stay (LOS). We analyzed a total of 39,742 patients with the use of the International Classification of Disease, ninth revision codes. The patients were categorized in the following two groups: group 1, individuals with a history of massive weight loss within 6 months before LFS, and group 2, individuals without a history of massive weight loss before surgery. Massive weight loss was defined as loss of 10% of total body weight. Patients with a history of malignancy or chronic disease were excluded from the study. Patients in each group were randomly matched based on age, gender, sex, smoking status, and body mass index. Paired two-tailed Student t-tests were used to compare the outcomes. Results Of the 39,742 patients identified, 129 (0.32%) met the criteria for inclusion in the weight loss group (WL group) and were successfully matched to individuals in the non-weight loss group (non-WL group). Compared with the non-WL group, the WL group had a significantly longer LOS (9.7 vs. 4.0 days, p

Resumen: La estenorraquis lumbar es la disminución del volumen del canal raquídeo en la columna. Es la causa más frecuente de dolor lumbociático y lumbocrural en población mayor de 60 años. Existen múltiples causas. La más común es la degenerativa que consiste en una disminución del canal secundario a varios factores como protrusión del disco intervertebral, hipertrofia y abombamiento del ligamento amarillo, engrosamiento de la capsula articular y por osteofitos. Los síntomas principales son el dolor lumbar irradiado a extremidades inferiores tipo lumbociática o lumbocruralgia y la claudicación neural intermitente. Generalmente no hay déficit motor ni sensitivo. La resonancia magnética es el estudio de elección para el diagnóstico, pero debe complementarse con radiografías y con frecuencia con tac para una mejor valoración de la patología. El tratamiento inicial siempre es conservador, que incluye uso de antiinflamatorios, analgésicos, relajantes musculares, kinesioterapia e infiltraciones de columna (epidurales o radiculares). La mayoría de los pacientes responden satisfactoriamente a este manejo. El tratamiento quirúrgico está indicado a los pacientes que presentan un dolor intenso, que afecta su calidad de vida y que no mejora con el tratamiento conservador. Consiste en la descompresión quirúrgica de las raíces lumbares a través de laminectomía. En ocasiones se recomienda complementar la descompresión con artrodesis específicamente cuando la estenorraquis se asocia a otras condiciones como espondilolistesis degenerativa, escoliosis, desbalance sagital o coronal, inestabilidad segmentaria y en enfermedad del segmento adyacente. Summary: Spinal lumbar stenosis is a narrowing of the spinal canal in the lumbar spine. Is the most frequent cause of sciatic pain or cruralgia in the elderly population over 60 years old. Exist many etiologies. The most common is degenerative caused by many factors including bulging disc, hypertrophy of flavum ligament as well as facet capsule thickening and by osteophytes formation. The main symptoms of spinal stenosis are radicular pain and neurogenic claudication. Lumbar flexion usually improves the symptom and deambulation often worsens the pain. Most of the time neurologic examination is normal. The gold standard study is mri but is necessary to complement with x rays and ct to obtain a better evaluation.Initial treatment is always conservative and consists in nsaid's, muscle relaxants, physical therapy and steroid spinal injections. Most of the patients respond well to this treatment. Surgical treatment is indicated when the patient has a severe pain, quality of life is miserable and conservative treatment fails. Decompression is the gold standard surgical treatment. The addition of an arthrodesis or spinal fusion is recommended in degenerative spondylolisthesis, scoliosis, sagital or coronal imbalance, deformity correction, recurrent spinal stenosis and in cases of adjacent level disease problem.

Fetiform teratoma is a rare highly developed mature teratoma with organoid differentiation although it is not as developed as fetus in fetus which is the only differential diagnosis of this entity. It should be distinguished from the fetus in fetu by absence of the axial skeleton. A 6-month-old baby girl with a lumbar lump underwent ultrasonography, CT-scan and surgery. On imaging, a sac-like structure was noted in the lumbar region containing bowel segments, mesentery-like structure and few lymph nodes. The patient underwent surgery. The entire sac with its content were completely excised. Very few cases of fetiform teratoma have been reported in English literature however to the best of our knowledge lumbar fetiform teratoma has not been reported up to now. Highly developed teratoma is a diagnostic dilemma as it resembles fetus in fetu. The absence of a spinal axis differentiates this entity from the fetus in fetu.

Amaç: Bu çalışmanın amacı böbrek nakil sonrası dönemde lomber ve femoral kemik mineral yoğunluğundaki (KMY) değişiklikleri değerlendirmektir.Gereç ve Yöntemler: Bu retrospektif çalışmaya, Ocak 2016 ve Temmuz 2019 tarihleri arasında böbrek nakli yapılan ardışık 69 erişkin (>18 yaş) hasta dahil edildi. Hastaların demografik özellikleri ve laboratuvar bulguları (serum düzeltilmiş kalsiyumu, fosfor, alkalen fosfataz, kreatinin, eGFR, i-parathormon ve 25(OH) D vitamin düzeyi) ile ilgili veriler kaydedildi. KMY, dual enerji X-ray absorbsiyometri (DEXA) ile değerlendirildi.Bulgular: DEXA sonuçlarına göre, lomber ve femoral T skorları sırasıyla -1,1±1,3 ve -1,1±1,1 idi. Lomber değerlendirmede 12 (%17,4) hastada osteoporoz ve 24 (%34,8) hastada osteopeni saptandı. Femoral değerlendirmede 7 (%10,1) hastada osteoporoz ve 29 (%42,0) hastada osteopeni saptandı. İlk yıl, 1-2 yıl ve >2 yıl takip verilerine göre, sırasıyla lomber bölgede hastaların %4,3, %5,8 ve %7,2’sinde, femurda hastaların %2,9, %2,9 ve %4,3’ünde osteoporoz saptandı. Lomber bölge (p=0,197) ve femurda (p=0,971) KMY kaybı tespit edilen hastalar ile KMY ölçümü normal olan hastalar arasında kümülatif steroid dozu açısından anlamlı bir fark yoktu. Ayrıca hastaların almış olduğu indüksiyon tedavisi ile lomber bölge (p=0,671) ve femurda (p=0,126) gelişen KMY kaybı arasında anlamlı bir ilişki görülmedi.Sonuç: Sonuç olarak, nakil hastalarında 25(OH) D vitamini eksikliği oldukça yaygındır ve özellikle nakilden sonraki ilk yıl lomber bölgede belirgin olmak üzere KMY kaybı görülmektedir.

The radiographic, ultrasonographic, and scintigraphic findings of horses with thoracolumbosacral pain have been previously reported. In this study, the computed tomographic appearance of anatomical variations and pathological changes of the equine caudal lumbar region through a post-mortem examination were investigated. A total of 40 horses that had died or were submitted for euthanasia, for reasons unrelated to the study, were included in the study. From all the specimens, the modified vertebral system was adopted to evaluate and describe the four most caudal lumbar vertebrae, which were numbered from a caudal reference point (lumbosacral junction), with the segment number designated within parentheses (i.e., L(i)-L(iv)). Contact of the spinous processes was detected in 21 specimens (54%) and fusion in 6 specimens (15%). Lumbar spondylosis was seen in 17 specimens (42.5%), more commonly on the lateral aspect or on both ventral and lateral aspects in 12 specimens (71%). The presence of spondylosis was found more commonly in older horses (p < 0.001). There was no difference in bony density in specimens with spondylosis or spinous processes contact compared to specimens without. The highest prevalence of bony changes was found at L(ii)-L(i) intertransverse joints in 28 specimens (97%) on the left and in 22 specimens (96%) on the right side. Spondylolisthesis and partial fusion of the L(ii)-L(i) vertebral disc were found in association with degenerative pathologies. This study showed a high frequency of several anatomical variations and acquired osseous pathological changes in the most caudal lumbar vertebrae via a CT examination.

Copyright of Revista Brasileira de Medicina do Esporte is the property of Redprint Editora Ltda. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Chondrosarcoma is a malignant tumour of cartilage, usually named and classified by anatomic location. Primary chondrosarcoma is the third most common primary tumour of bone, after myeloma and osteosarcoma. Commonest sites of presentation are pelvic bones, long bones and relatively rare in ribs. Here we report a case of 75 year old male who presented with a swelling over the left lower lumbar region, which increased gradually in size in three months. The swelling was not associated with pain or trauma. After initial clinical workup, he was referred to the Radiology Department, for Computerized Tomography (CT) scan. On correlating the findings in the CTscan report, he was further referred to the Histopathology Department for Fine Needle Aspiration Cytology (FNAC) in view of definite diagnosis. Initial diagnosis on FNAC was given as chondrosarcoma in favour of the location of the swelling. Furthermore excision biopsy was done. The definitive diagnosis was given as dedifferentiated chondrosarcoma. FNAC of dedifferentiated lesions due to its rarity and limited experience poses a challenge to many histopathologists.

Low back pain is the most common cause of disability. Epidemiological studies have generally considered that risk factors for starting backache are interrelated in three dimensions: individual factors and lifestyle, physical or biomechanical factors, and psychosocial factors. The main aim of this study was to evaluate the efficacy of physical therapy in patients with chronic non-specific low back pain. This retrospective study was conducted at the Diagnostic Therapeutic Center Rezonanca, Department of Physiotherapy in Prishtina, Kosovo, during the period January-March 2017. Analyzed data were collected from year 2015-2016, included physiotherapeutic reports of patients of both sexes, Lasegue’s test and improvement of the patients after 10 sessions of physical therapy treatment. The main criteria for inclusion in the research was chronic non-specific low back pain with a duration of more than 6 months. According our results we found statistical significance difference regarding the overall condition of treatment from the total number of patients (t=2.004, p

Study Design: Survey study.Objective: Assess practices and opinions of spine specialists from Europe and North America on orthosis use in adult patients with acute thoracolumbar (TL) fractures. Evaluate cost of the devices.Summary Of Background Data: Although orthosis are traditionally used in conservative treatment of TL fractures, recent systematic reviews showed no benefit in patient's outcomes.Methods: A search for contact authors with publications on spine fractures from all European and North American countries was performed. An online questionnaire was sent on demographic data, practice setting, mean number of fractures treated, use of orthosis upon choice for conservative treatment, and average orthosis cost. Data was analyzed based in world regions, economic rank of the country, and health expenditure.Results: We received 130 answers, from 28 European and five North American countries. Most responders had more than 9 years of practice and worked at a public hospital. 6.2% did not prescribe a brace in any patient with acute TL fractures conservatively treated and 11.5% brace all patients. In a scale from 1 to 5, 21 considered that there is no/low benefit (1) and 14 that bracing is essential (5), with a mean of 3.18. Europeans use orthosis less commonly than North Americans (P < 0.05). Orthosis mean cost was $611.4 ± 716.0, significantly higher in North America compared with Europe and in high income, when compared with upper middle income countries (both P < 0.05). Although hospital costs were not evaluated, orthosis is costlier when it involves admission of the patient (P < 0.05). An increase in orthosis cost associated with higher gross domestic product (GDP) per capita and higher health expenditure was found.Conclusion: More than 90% of spine specialists still use orthosis in conservative treatment of adult patients with acute TL fractures. Orthosis cost vary significantly between continents, and it is influenced by the country's economy.Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Introduction: Postural alignment is commonly assessed, and the abnormal postures are associated with musculoskeletal disorders. There are different methods for screening spinal column anomalies. The flexible ruler provides a safe, portable, inexpensive and non-invasive way to measure the spinal curvature in clinical and larger population. Aim: To determine the intra-rater and inter-rater reliability of flexible ruler in measuring lumbar lordosis among children. Materials and Methods: In this cross-sectional study 81 school children that fulfilled the criteria were recruited with age ranging from 9 to 15 years. Youdas method in standing position was adopted. By using flexible ruler, measurement was taken and without altering the shape of the lumbar curve it was traced in a graph sheet. By using straight ruler, line L and H were drawn by following deep point method. Lumbar lordosis angle was calculated by using the formula, θ=4Arctan 2H/L. Intra-rater reliability: Four measurements were taken by evaluator 1 with a gap of one minute between first two measurements and 3 minutes rest then other two measurements were taken with a gap of one minute between each. The average of first two and the last two measurements were considered as measurements 1 and 2. Inter rater reliability: Two measurements were taken by evaluator 2 by adapting the same procedure. The averages of two measurements were considered as measurement for evaluator 2. This value was correlated with the value of measurement 1 of evaluator 1. The data was analysed using Intra Class Correlation coefficient (ICC) test. Results: The results showed high intra-rater reliability (ICC0.991; p

Abdominal hernias represent common conditions and occur when a structure of the abdominal cavity protrudes through a defect in the abdominal wall. Recently, there has been an increase in demand from the clinical teams to confirm the clinical suspicion of an abdominal wall hernia, and to assess preoperatively large or complex hernias through imaging. This pictorial review aims to present the different appearances of abdominal wall and lumbar region hernias on imaging.

Study Design In vitro cadaveric study. Purpose To compare biomechanical performance, trial and implant insertion, and disc distraction during implant placement, when two interbody devices, an in situ continuously expandable spacer (CES) and a traditional static spacer (SS), were used for transforaminal lumbar interbody fusion. Overview of Literature Severe degenerative disc diseases necessitate surgical management via large spacers to increase the disc space for implants. Next-generation interbody devices that expand in situ minimize insertion forces, optimize fit between vertebral endplates, and limit nerve root retraction. However, the literature lacks characterization of insertion forces as well as details on other parameters of expandable and static spacers. Methods Ten cadaveric segments (L5–S1) were divided into two groups (n=5) and implanted with either CES or SS. Each specimen experienced unconstrained pure moment of ±6 Nm in flexion–extension, lateral bending, and axial rotation to assess the contribution of CES and SS implants in biomechanical performance. Radiographic analysis was performed during trial and implant insertion to measure distraction during spacer insertion at the posterior, central, and anterior disc regions. Pressure sensors measured the force of trial and implant insertion. Results Biomechanical analysis showed no significant differences between CES and SS in all planes of motion. A total 2.6±0.9 strikes were required for expandable spacer trials insertion and 2.6±0.5 strikes for CES insertion. A total of 8.4±3.8 strikes were required to insert SS trials and 4.2±1.6 strikes for SS insertion. The total force per surgery was 330 N for CES and 635 N for SS. Fluoroscopic analysis revealed a significant reduction in distraction during implant insertion at the posterior and anterior disc regions (CES, 0.58 and 0.14 mm; SS, 1.04 and 0.78 mm, respectively). Conclusions Results from the three study arms reveal the potential use of expandable spacers. During implant insertion, CESs provided similar stability, required less insertion force, and significantly reduced over-distraction of the annulus compared with SS.

Study Design: Prospective, comparative. Purpose: To compare the histopathological and electron microscopic changes in the ligamentum flavum (LF) between degenerative lumbar canal stenosis (LCS) and lumbar disk herniation (LDH). Overview of Literature: The LF has been implicated as a key structure in the pathogenesis of LCS. With aging, the LF undergoes morphological changes-a decrease in the elastic component and an increase in the collagen component, in addition to other focal changes. By comparing the histopathological and electron microscopic picture of the LF in elderly patients with LCS with that in young patients with LDH, the role of this ligament in the pathogenesis of LCS may be clarified. Methods: Forty patients were prospectively recruited and divided into two groups: group 1 included 20 patients with degenerative LCS aged >55 years and group 2 included patients with LDH aged <35 years. The ligament flava were collected during the patients' surgery. The features noted on histopathological examination included the fibrosis score, the loss of elastic fibers, calcification, chondroid metaplasia, mucinous degeneration, vascularization, long septa, clefts, granulation tissue, and ganglion-like cysts. The features noted on electron microscopic examination included the elastic fiber thickness, the quality of elastic fibers, the elastic:collagen ratio, calcification, melanin fibers, remnants of necrotic cells, and electron-dense material in the LF. All parameters were compared between group 1 and group 2. Results: On histopathological examination, the two groups exhibited significant differences regarding three parameters: chondroid metaplasia, long septa, and ganglion-like cysts. On electron microscopy examination, significant differences were observed between the two groups regarding two parameters: the quality of elastic fibers and the elastic:collagen ratio. Conclusions: Characteristic morphological changes may be noted on histopathological and electron microscopic examination that mark the degenerative changes in the LF that contribute to the occurrence and pathogenesis of degenerative LCS. [ABSTRACT FROM AUTHOR]

Study Design: Systematic review and meta-analysis of randomized controlled trial (RCT).Objective: The aim of this study was to evaluate radiological and clinical outcomes of acute traumatic thoracolumbar fractures in skeletally mature patients treated with orthosis, versus no immobilization.Summary Of Background Data: Orthosis is traditionally used in conservative treatment of thoracolumbar fractures. However, recent studies suggest no benefit, and a possible negative impact in recovery.Methods: Databases were searched from inception to June 2019. Studies were selected in two phases by two blinded reviewers; disagreements were solved by consensus. Inclusion criteria were: RCT; only patients with acute traumatic thoracolumbar fractures; primary conservative treatment; comparison between orthosis and no orthosis. Exclusion criteria were inclusion of nonacute fractures, patients with other significant known diseases and comparison of groups different than use of an orthosis. Two independent reviewers performed data extraction and quality assessment. Fixed-effects models were used upon no heterogeneity, and random-effects model in the remaining cases. A previous plan for extraction of radiological (kyphosis progression; loss of anterior height) and clinical (pain; disability; length of stay) outcomes was applied. PRISMA guidelines were followed.Results: Eight articles/five studies were included (267 participants). None reported significant differences in pain, kyphosis progression, and loss of anterior height. One reported a better ODI with orthosis at 12 but not at 24 weeks. No other study reported differences in disability. All authors concluded an equivalence between treatments.Meta-analysis showed a significant increase of 3.47days (95% confidence interval 1.35-5.60) in mean admission time in orthosis group. No differences were found in kyphosis at 6 and 12 months; kyphosis progression between 0 to 6 and 0 to 12 months; loss of anterior height 0 to 6 months; VAS for pain at 6 months; VAS change 0 to 6 months.Conclusion: Orthosis seems to add no benefit in conservative treatment of acute thoracolumbar fractures. This should be considered in guidelines and reviews of health care policies.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort study. Purpose: To determine the effects of massive weight loss on perioperative complications after lumbar fusion surgery (LFS). Overview of Literature: Patients who are obese are more likely to experience low back pain, which would require LFS. Nonetheless, they have a higher risk of perioperative complication development compared with individuals who are not obese. Methods: Patients who underwent LFS at hospitals that participated in the National Surgical Quality Improvement Program database within the United States between 2005 and 2015. Outcomes included 30-day medical complications, surgical complications, and length of stay (LOS). We analyzed a total of 39,742 patients with the use of the International Classification of Disease, ninth revision codes. The patients were categorized in the following two groups: group 1, individuals with a history of massive weight loss within 6 months before LFS, and group 2, individuals without a history of massive weight loss before surgery. Massive weight loss was defined as loss of 10% of total body weight. Patients with a history of malignancy or chronic disease were excluded from the study. Patients in each group were randomly matched based on age, gender, sex, smoking status, and body mass index. Paired two-tailed Student t -tests were used to compare the outcomes. Results: Of the 39,742 patients identified, 129 (0.32%) met the criteria for inclusion in the weight loss group (WL group) and were successfully matched to individuals in the non-weight loss group (non-WL group). Compared with the non-WL group, the WL group had a significantly longer LOS (9.7 vs. 4.0 days, p<0.05), higher surgical site infections (SSIs) (8.0 vs. 3.0, p<0.05), increased number of blood transfusions (40.0 vs. 20.0, p<0.05), and greater deep vein thrombosis (DVTs) (5.0 and 0.00, p<0.05). Conclusions: On a nationwide scale, rapid weight loss before LFS is associated with a higher rate of postoperative complications, including SSI and DVTs, longer average LOS, and more frequent blood transfusions. [ABSTRACT FROM AUTHOR]

Background: Lumbar disc herniation (LDH) is one of the most often diagnosed degenerative pathologies within the lumbar spine. Paraspinal muscle involvement could be a possible mediator in the pathophysiology of disc herniation and influences the course of pain and disability after both surgical or nonsurgical treatment. To potentially improve treatment, it may be important to assess multifidus muscle morphology in patients diagnosed with a LDH.Objective: A systematic literature review and meta-analysis regarding the multifidus morphology in patients diagnosed with a LDH was conducted to assess the differences in multifidus muscle morphology between persons with LDH and healthy controls, and between the involved and the uninvolved side within subjects experiencing unilateral LDH.Methods: A systematic search was conducted of articles published up to and including November 2019 using the Pubmed, Web of Science, EMBASE, and MEDLINE Ovid search engines. The articles obtained from this search were screened based on title and abstract using the predetermined eligibility criteria. Included full text articles were assessed for their methodologic quality using the modified Downs and Black checklist. Heterogeneous data regarding multifidus muscle morphology was included in the descriptive analysis; data that was homogenous was included in the meta-analysis.Results: We identified 3,176 articles. Based on the screening for inclusion/exclusion criteria, 18 articles were included. Studies were either cross sectional or case-control studies assessing side-to-side differences or comparing patients diagnosed with a LDH to a healthy control group. Nine studies investigated whole muscle atrophy, six looked at muscle fat infiltration, seven studies assessed microscopic muscle properties including muscle fiber size, distribution, and muscle fibrosis. From the 18 articles, 10 were included in the meta-analysis. In the meta-analysis, a comparison was made between side-to-side differences for muscle fiber size, distribution, and whole muscle size. Descriptive analysis showed increased fat infiltration and atrophy (muscle and individual fiber) of the multifidus muscle when comparing side-to-side differences or comparing cases to controls. Meta-analysis showed a significant decrease in type I and II muscle fiber size (p=.002, .01, respectively) combined with a significant increase in the number of type I muscle fibers (p=.008) at the side of LDH. Regarding whole muscle size, no significant differences were found.Conclusions: This study shows the presence of ipsilateral multifidus muscle changes in persons with unilateral LDH. [ABSTRACT FROM AUTHOR]

Copyright of Revista Médica Clínica Las Condes is the property of Editorial Sanchez y Barcelo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Pain in the lumbar region is a common medical problem affecting people of different ages, sex and race. Data shows that pain in the lumbar region is affecting more and more young people, with cases of disc herniation in 12-year-old patients. Pain in the lumbar region can be of different nature - traumatic, neurological, degenerative and psychological. Statistics show that 70-80% of people have had some low back pain at some moment of their life. According to some authors, in 85% of patients with this pain no definitive cause can be identified due to the weak relationship between symptoms and the results of diagnostic images, and others report that cases of lower back pain can be attributed to a specific pain generator, with its own characteristics and different therapeutic options. Depending on the manifestation of the lower back pain, some authors describe low back pain as acute, subacute, recurrent, and chronic. Low back pain is defined by experts as an "epidemic" in the modern world. Data from research in the field show that people with episodes of low back pain often repeat them (24% -33%). Some authors report that lower back pain is often caused by non-pathological functional disorders. Pain is not always related to a certain age and gender – both young and older people, women and men suffer. Epidemiological studies show that the morbidity is about 30%, increasing from the age of 30 onwards to reach a maximum of about 55-64 years. Because of incorrect treatment of acute idiopathic low back pain, incorrect work posture, weak muscles and continuous overloading of the low back can lead to chronic low back pain. The chronicity of the disease leads to the development of degenerative changes in the intervertebral joints and degeneration of the vertebrae. The high frequency of low back pain and the difficult differentiation of their etiology have led to their being called syndrome of low back pain (low back pain). One of the reasons for the distribution of lumbar pain is lifestyle - the lack of physical activity, which leads to detraining of the muscles that support the spine. Diseases of the spine lead to spontaneous pain, tightness, limited movement, deformities and various neurological symptoms. According to the pathophysiological mechanisms that cause it, the pain is nociceptive or neuropathic. Nociceptive pain is local and occurs as a result of activation of nociceptors by damaging stimuli. Neuropathic pain occurs directly as a result of a lesion or disease affecting the somatosensory nervous system. People with pain of lumbar region are grouped into 4 groups according to the therapeutic approach to which they are subjected. Pain in the lumbar region are characterized by different reasons and duration. The variety of causes of lumbar pain are related to a different therapeutic approach. Knowledge of the characterization of lumbar pain allows us to apply adequate therapeutic means, and this will lead to a good response to pain treatment. [ABSTRACT FROM AUTHOR]

The link between static and dynamic landing lumbar postures, when gymnasts are exposed to large ground reaction forces, has not been established. This investigation aimed to (a) determine if a relationship exists between sagittal static and dynamic landing lumbar spine angles at peak ground reaction force (GRF) and (b) quantify how close to end-range postures the gymnasts were at landing peak GRF. Twenty-one female gymnasts' upper and lower lumbar spine angles were recorded: statically in sitting and standing, during landing of three gymnastic skills, and during active end-range lumbar flexion. Pearson's correlations were used to investigate relationships between the angles in different postures. Significant correlations (r = .77-.89, p < .01) were found between all the static/dynamic postures in the lower lumbar spine angle, while fewer and less significant upper lumbar spine correlations were reported. Thirty percent of gymnasts landed a backsault with their lower lumbar spine flexed beyond their active end-range while experiencing GRF 6.8-13.3 times their body weight. These results inform low back pain prevention and management strategies in this population and highlight areas for future research. [ABSTRACT FROM AUTHOR]

Retroperitoneal Cysts (RPC) are uncommon, with an estimated incidence of 1 in 5,750 to 1 in 250,000. A 26-year-old woman presented with dull aching, non-radiating pain in the upper abdomen for the past two months, with no aggravating or relieving factors. On clinical examination of the abdomen, a grossly visible mass measuring approximately 10x10 cm with a smooth surface, firm consistency, and well-defined borders was observed in the left lumbar and iliac region. Contrast-Enhanced Computed Tomography (CECT) of the abdomen and pelvis revealed a well-circumscribed cystic lesion measuring 9.3x9.5x5.5 cm in the left lumbar region near the tail of the pancreas. The pancreas appeared normal with no surrounding fat stranding or inflammatory changes. Peripheral enhancement and peripheral wall calcification were observed. The patient underwent laparotomy and cyst excision. Intraoperatively, the cyst was found to arise from the retroperitoneum located in the lesser sac. It was dissected out from the tail of the pancreas, and no obvious communication with the pancreas was observed. The cyst was excised completely. Histopathological examination revealed a cyst with absent endothelium, suggestive of a pseudocyst. Previous literature reports indicate that RPCs are very rare and are often discovered incidentally. Patients may be asymptomatic or present with vague symptoms. Imaging can help diagnose these lesions, but surgery is crucial in confirming the diagnosis. [ABSTRACT FROM AUTHOR]

Study DesignIn vitro biomechanical investigation.PurposeTo compare the biomechanics of integrated three-screw and four-screw anterior interbody spacer devices and traditional techniques for treatment of degenerative disc disease.Overview of LiteratureBiomechanical literature describes investigations of operative techniques and integrated devices with four dual-stacked, diverging interbody screws; four alternating, converging screws through a polyether-ether-ketone (PEEK) spacer; and four converging screws threaded within the PEEK spacer. Conflicting reports on the stability of stand-alone devices and the influence of device design on biomechanics warrant investigation.MethodsFourteen cadaveric lumbar spines were divided randomly into two equal groups (n=7). Each spine was tested intact, after discectomy (injured), and with PEEK interbody spacer alone (S), anterior lumbar plate and spacer (AP+S), bilateral pedicle screws and spacer (BPS+S), circumferential fixation with spacer and anterior lumbar plate supplemented with BPS, and three-screw (SA3s) or four-screw (SA4s) integrated spacers. Constructs were tested in flexion-extension (FE), lateral bending (LB), and axial rotation (AR). Researchers performed one-way analysis of variance and independent t-testing (p≤0.05).ResultsInstrumented constructs showed significantly decreased motion compared with intact except the spacer-alone construct in FE and AR (p≤0.05). SA3s showed significantly decreased range of motion (ROM) compared with AP+S in LB (p≤0.05) and comparable ROM in FE and AR. The three-screw design increased stability in FE and LB with no significant differences between integrated spacers or between integrated spacers and BPS+S in all loading modes.ConclusionsIntegrated spacers provided fixation statistically equivalent to traditional techniques. Comparison of three-screw and four-screw integrated anterior lumbar interbody fusion spacers revealed no significant differences, but the longer, larger-diameter interbody spacer with three-screw design increased stabilization in FE and LB; the diverging four-screw design showed marginal improvement during AR.

Abstract Background Degenerative joint disease (DJD) in the lumbar spine is a common condition that is associated with chronic low back pain. Excessive loading of lumbar joints is a risk factor for DJD. Changes in lumbar lordosis significantly redistribute the forces of weight-bearing on the facet joints and the intervertebral discs. However, the relationship between lumbar lordosis and DJD has not been characterized in men and women. Methods We characterised the correlation between standing lumbar lordosis and DJD in standing radiographic images from 301 adult female and male chiropractic patients. DJD was rated using the Kellgren-Lawrence scale, and lordosis was measured using the Cobb angle. Linear and curvilinear correlations were investigated while controlling for age and sex. Results We found a highly significant curvilinear correlation between lordosis and DJD of the lower lumbar spine in both sexes, but especially in women, irrespective of the effects of age. We found the effect size of lordosis on lower lumbar DJD to be between 17.4 and 18.1% in women and 12.9% in older men. In addition, lordosis of 65 (95% CI 55.3–77.7) and 68 (98% CI 58.7–73.3) degrees were associated with minimal DJD in the lower lumbar spine of women and men respectively, and were therefore considered ‘optimal’. This optimal lordotic angle was 73 (95% CI 58.8–87.2) degrees in older men. Conclusions Both hypo- and hyper-lordosis correlate with DJD in the lumbar spine, particularly in women and in older men. These findings may well be of relevance to spinal pain management and spinal rehabilitation.

Study DesignCross-sectional retrospective study designed to assess interobserver agreement.PurposeTo investigate if interobserver agreement using magnetic resonance imaging (MRI) in the evaluation of lumbar spinal canal stenosis and root compression can be improved upon combination with magnetic resonance myelography (MRM).Overview of LiteratureThe interpretation of lumbar spinal MRI, which is the imaging modality of choice, often has a significant influence on the diagnosis and treatment of low back pain. However, using MRI alone, substantial interobserver variability has been reported in the evaluation of lumbar spinal canal stenosis and nerve root compression.MethodsHardcopies of 30 lumbar spinal MRI (containing a total of 150 disk levels) as well as MRM films were separately reviewed by two radiologists and a neurosurgeon. At each intervertebral disk, the observers were asked to evaluate the thecal sac for the presence and degree of spinal stenoses (mild, moderate, or severe) and presence of root canal compression. Interobserver agreement was measured using weighted kappa statistics.ResultsRegarding lumbar spinal canal stenosis, interobserver agreement between the two radiologists was moderate (kappa, 0.4) for MRI and good (kappa, 0.6) for combination with MRM. However, the agreement between the radiologist and neurosurgeon remained fair for MRI alone or in combination with MRM (kappa, 0.38 and 033, respectively). In the evaluation of nerve root compression, interobserver agreement between the radiologists improved from moderate (kappa, 0.57) for MRI to good (kappa, 0.73) after combination with MRM; moderate agreement between the radiologist and neurosurgeon was noted for both MRI alone and after combination with MRM (kappa, 0.58 and 0.56, respectively).ConclusionsInterobserver agreement in the evaluation of lumbar spinal canal stenosis and root compression between the radiologists improved when MRM was combined with MRI, relative to MRI alone.