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Quantitative correlation of lumbar foraminal stenosis with local morphological metrics

http://monchiropracteur.com/ monchiropracteur.com Abstract Purpose Clinical evaluation of lumbar foraminal stenosis typically includes qualitative assessments of perineural epidural fat content around the spinal nerve root and evaluation of nerve root impingement. The present study investigates the use of several morphological MRI-derived metrics as quantitative predictors of foraminal stenosis grade. Methods 62 adult patients that underwent lumbar spine MRI evaluation over a 1-month duration in 2018 were included in the analysis. Radiological gradings of stenosis were captured from the existing clinical electronic medical record. Clinical gradings were recorded using a 0–5 scale: 0 = no stenosis, 1 = mild stenosis, 2 = mild-moderate stenosis, 3 = moderate stenosis, 4 = moderate-severe stenosis, 5 = severe stenosis. Quantitative measures of perineural epidural fat volume, nerve root cross-sectional area, and lumbar pedicle length were derived from T1 weighted sagittal spine MRI on each side of all lumbar levels. Spearman correlations of each measured metric at each level were then computed against the stenosis gradings. Results A total of 347 volumetric segmentation and radiological foraminal stenosis grade sets were derived from the 62-subject study cohort. Statistical analysis revealed significant correlations (p  http://link.springer.com/10.1007/s00586-021-06944-8?utm_source=dlvr.it&utm_medium=tumblr http://monchiropracteur.com/

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Expected impact of lockdown measures due to COVID-19 on disabling conditions: a modelling study of chronic low back pain

http://monchiropracteur.com/ monchiropracteur.com Abstract Purpose The COVID-19 pandemic and the containment measures such as social distancing, mobility restrictions and quarantine have significantly impacted the delivery of healthcare services, with possible negative effects on low back pain patients. In this study, we used an innovative agent-based model to quantify the effects of COVID-19 on the prevalence and severity of low back pain in the general population. Methods Epidemiological data were used to simulate the low back pain evolution in a population of 300,000 agents. Reduced access to treatment due to the containment measures was simulated with a probabilistic approach, in which 500 random scenarios (differing in: length of the lockdown, probability of having access to treatment, time before the resumption of treatment, duration of the effects of the treatment after its interruption) were simulated. Results The lockdown may increase the mean pain score higher than 1/10 points for patients suffering from acute low back pain, up to 4–5/10 points for specific individuals. The lockdown also affected the length of pain episodes, possibly impacting chronicity and disability. All the variables describing the random scenarios had a relevant impact in determining both the increase of pain intensity in the population and the length of the effects of the lockdown. Conclusions “Optimal lockdown parameters” which minimize the impact on low back pain while preserving the effects on infection spread and mortality could not be identified. Policies favouring a prompt resumption of treatments after the lockdown may be effective in shortening the duration of its negative effects. http://link.springer.com/10.1007/s00586-021-06940-y?utm_source=dlvr.it&utm_medium=tumblr http://monchiropracteur.com/

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Letter to the Editor concerning "Pedicle screw fixation of thoracolumbar fractures: conventional short segment versus short segment with intermediate screws at the fracture level—a systematic review and meta-analysis" by C. Kapoen, et al. [Eur Spine J; 2020; 29(10):2491–2504]

http://monchiropracteur.com/ monchiropracteur.com http://link.springer.com/10.1007/s00586-021-06935-9?utm_source=dlvr.it&utm_medium=tumblr http://monchiropracteur.com/

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Radiological features of cervical spine in dropped head syndrome: a matched case–control study

http://monchiropracteur.com/ monchiropracteur.com Abstract Purpose Dropped head syndrome (DHS) is presumably caused by focal myopathy in the cervical posterior muscles; however, distinguishable radiological features of the cervical spine in DHS remain unidentified. This study investigated the radiological features of the cervical spine in dropped head syndrome. Methods The records of DHS patients and age- and sex-matched cervical spondylotic myelopathy (CSM) patients were reviewed. Cervical spinal parameters (C2-7, C2-4, and C5-7 angles) were assessed on lateral cervical spine radiographs. Quantitative radiographic evaluation of cervical spine degeneration was performed using the cervical degenerative index (CDI), which consists of four elements: disk space narrowing (DSN), endplate sclerosis, osteophyte formation, and listhesis. Results Forty-one DHS patients were included. Statistically significant differences were noted between the upper and lower cervical spine in the sagittal angle parameters on the neutral, flexion, and extension radiographs in DHS group, whereas no significant differences were observed in CSM group. CDI comparison showed significantly higher scores of DSN in C3/4, C4/5, C5/6, and C6/7; sclerosis in C5/6 and C6/7; and osteophyte formation in C4/5, C5/6, and C6/7 in DHS group than in CSM group. Comparison of listhesis scores revealed significant differences in the upper levels of the cervical spine (C2/3, C3/4, and C4/5) between two groups. Conclusion Our results demonstrated that the characteristic radiological features in the cervical spine of DHS include lower-level dominant severe degenerative change and upper-level dominant spondylolisthesis. These findings suggest that degenerative changes in the cervical spine may also play a role in the onset and progression of DHS. http://link.springer.com/10.1007/s00586-021-06939-5?utm_source=dlvr.it&utm_medium=tumblr http://monchiropracteur.com/

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Lifting advice doesn't stand up for everyone, study finds

http://monchiropracteur.com/ monchiropracteur.com Commonly accepted advice to keep a straight back and squat while lifting in order to avoid back pain has been challenged by new research. The research examined people who had regularly performed manual lifting through their occupation for more than five years and found those who experienced low back pain as a result were more likely to use the recommended technique of squatting and keeping a straight back, while those without back pain tended not to adhere to the recommended lifting advice. https://www.sciencedaily.com/releases/2021/07/210721142007.htm?utm_source=dlvr.it&utm_medium=tumblr http://monchiropracteur.com/

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The role of sagittal pelvic morphology in the development of adult degenerative scoliosis

http://monchiropracteur.com/ monchiropracteur.com Abstract Purpose Pelvic morphology dictates the alignment and biomechanics of the spine. Recent observations in different types of adolescent idiopathic scoliosis indicate that individual pelvic morphology is related to the spinal levels in which scoliosis develops: primary lumbar adolescent scoliosis is associated with a higher pelvic incidence (PI) than thoracic scoliosis and non-scoliotic controls. We hypothesize that adult degenerative scoliosis (ADS) of the lumbar spine follows the same mechanical principles and is associated with a high PI. Methods This study used an existing CT-scan database, 101 ADS patients were sex and age matched to 101 controls. The PI was measured by two observers with multi-planar reconstruction, perpendicular to the hip-axis according to a previously validated technique. Results The PI was 54.1° ± 10.8° in ADS patients and 47.7° ± 10.8° in non-scoliotic controls (p  http://link.springer.com/10.1007/s00586-021-06924-y?utm_source=dlvr.it&utm_medium=tumblr http://monchiropracteur.com/

[monchiropracteur]

Association analysis and functional study of COL6A1 single nucleotide polymorphisms in thoracic ossification of the ligamentum flavum in the Chinese Han population

http://monchiropracteur.com/ monchiropracteur.com Abstract Purpose Genetic factors play a crucial role in thoracic ossification of the ligamentum flavum (TOLF). This study aimed to better understand the association between single nucleotide polymorphisms (SNP) in functional regions of the collagen VI, alpha 1 gene (COL6A1) and TOLF, and to confirm COL6A1 as a TOLF susceptibility gene. Methods Ten tag SNPs in COL6A1 were genotyped using the SNaPshot assay, and allele and genotype frequencies were compared between TOLF patients and control individuals. The function of SNPs associated with disease was studied. For COL6A1 promoter SNPs, the transcriptional activity of each haplotype was determined by luciferase reporter assays. For COL6A1 exonic SNPs, the effect of nucleotide substitutions on COL6A1 expression was determined by western blotting. COL6A1 mRNA expression in ligamentum flavum tissues from TOLF patients with different genotypes was examined using reverse transcription real-time PCR. Results Four SNPs were associated or possibly associated with TOLF, with higher pathogenic allele and genotype frequencies seen in TOLF patients compared with controls. The rs17551710/rs7671-GG/GG genotype appeared to be related to disease severity. Nucleotide substitutions at rs17551710 and rs7671 increased COL6A1 transcriptional activity and nucleotide substitutions at rs1053312 and rs13051496 increased COL6A1 protein expression. COL6A1 mRNA expression was significantly up-regulated in individuals with rs17551710/rs7671-GG/GG and rs1053312/rs13051496-AA+AG/CC genotypes compared with other genotypes. Conclusion SNPs in the COL6A1 promoter and exonic regions are associated with TOLF in the Chinese Han population, and lead to up-regulated COL6A1 expression. We confirmed COL6A1 as a TOLF susceptibility gene that may be involved in TOLF pathology. http://link.springer.com/10.1007/s00586-021-06932-y?utm_source=dlvr.it&utm_medium=tumblr http://monchiropracteur.com/

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Pathological changes within two weeks following spinal cord injury in a canine model

http://monchiropracteur.com/ monchiropracteur.com Abstract Purposes This study aimed to investigate the histopathological changes that occur within 2 weeks following spinal cord injury (SCI) in dogs. Methods Eight adult female Beagle dogs were included in this study, and SCI was induced using an epidural balloon catheter. Two dogs were killed at each of the following four time points: immediately after the procedure and 1 day, 1 week, and 2 weeks after the procedure. Neurological status was evaluated with five categories. Histopathological changes were visually observed for stained sections of formalin-fixed spinal cord to evaluate hemorrhage, spongiosis, necrosis, and gliosis morphologically. Results Along the 2 weeks post-injury, severe hemorrhage was observed at the primary injury site, the average diameter of which expanded quickly from 8 to 10 mm in 1 day and then decreased to 5 mm in 1 week. This indicates that the bleeding cavity expanded at the initial injury site to produce ascending and descending hemorrhage. The hemorrhage at the injury site resolved in 2 weeks. In contrast, spongiosis, parenchymal necrosis, and gliosis were first inconspicuous or mild and then became severe in 1 week or 2 weeks. Hemorrhage, hematoma, and other similar changes occurred at the regions approximately 20-mm rostral and caudal to the primary injury site. These changes were observed in both gray matter and white matter. Conclusions This study is the first to assess the sequential histopathological changes in the acute and intermediate phases following SCI in dogs. Our findings enhance the usefulness of the canine intervertebral disk disease model in the assessment of secondary spinal cord histopathology in human SCI. http://link.springer.com/10.1007/s00586-021-06931-z?utm_source=dlvr.it&utm_medium=tumblr http://monchiropracteur.com/

[monchiropracteur]

Cerebrospinal fluid signal loss sign: assessment of a new radiological sign in lumbar spinal stenosis

http://monchiropracteur.com/ monchiropracteur.com Abstract Purpose Sedimentation sign was reported to have high sensitivity and specificity for diagnosis of lumbar spinal stenosis (LSS). We aimed to determine cerebrospinal fluid signal loss (CSFSL) at the intervertebral disc levels in the sagittal plane using a numerical scoring system and to evaluate the diagnostic value of this method in differential diagnosis of LSS and non-specific low back pain (LBP) and compare it with SS. Materials and methods We included consecutive patients between 50 and 80 years old, with lumbar spinal MRI examination in our institution. These patients were divided into two groups as LSS and LBP, according to symptoms and radiological findings. CSFSL sign was evaluated for both groups by two radiologists independently, using MR images. Sensitivity and specificity of both signs were calculated. Results A total of 406 patients (98 LSS and 308 non-specific LBP) were included. SS and CSFSL sign had a sensitivity of 90.8% and 82.7% and specificity of 75.4% and 84.1% in the whole cohort, respectively. When patients were grouped by dural sac cross-sectional areas (CSA), sensitivity and specificity of SS were 100% and 4.4%, 87.5% and 31.8%, and 41.7% and 76%, respectively, and sensitivity and specificity of CSFSL sign were 95.7% and 11.1%, 75% and 77.3%, and 16.7 and 92% for severe (CSA  http://link.springer.com/10.1007/s00586-021-06929-7?utm_source=dlvr.it&utm_medium=tumblr http://monchiropracteur.com/

[monchiropracteur]

Robotic neck brace can help analyze cancer treatment impacts

http://monchiropracteur.com/ monchiropracteur.com A new robotic neck brace may help doctors analyze the impact of cancer treatments on the neck mobility of patients and may help guide their recovery. https://www.sciencedaily.com/releases/2021/07/210719143424.htm?utm_source=dlvr.it&utm_medium=tumblr http://monchiropracteur.com/

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Histological examination of a retrieved custom-made 3D-printed titanium vertebra

http://monchiropracteur.com/ monchiropracteur.com Abstract Purpose In the present report it is described the design, the manufacturing and the successful surgical implant of one of the first 3D custom titanium vertebra realized with Additive Manufacturing technique and its use for the spinal reconstruction after en-bloc resection for primary osteogenic sarcoma. Methods Clinical case presentation and the design of the 3D custom titanium vertebra was reported. It was also described the complex procedures adopted to evaluate the retrieved device from the histological point of view, as a tumor relapse hit the patient, one year after the reconstruction procedure. Results The histological evaluation confirmed that the resection technique exerts an important role in promoting bone formation: vertebral body osteotomies favored the reconstruction procedure and maximized the contact area between host bone/vertebral prosthesis thus favoring the bone tissue penetration and device colonization. Conclusion The sharing of these results is very important as they represent the starting point for improving the knowledge starting from the evidence obtained in a challenging clinical condition and with post-operative treatments that could be never reproduced in preclinical model. http://link.springer.com/10.1007/s00586-021-06926-w?utm_source=dlvr.it&utm_medium=tumblr http://monchiropracteur.com/

[monchiropracteur]

Nerve root sedimentation sign on MRI: A triage screen for leg dominant symptoms?

http://monchiropracteur.com/ monchiropracteur.com Abstract Purpose Surgical indications for lumbar spinal stenosis are controversial, but most agree that leg dominant pain is a better predictor of success after decompression surgery. The objective of this study is to analyze the ability of the Nerve Root Sedimentation Sign (SedSign) on MRI to differentiate leg dominant symptoms from non-specific low back pain. Methods This was a retrospective review of 367 consecutive patients presenting with back and/or leg pain. Baseline clinical characteristics included Oswestry disability index (ODI), visual analog pain scores, EuroQol Group 5-Dimension Self-Report (EQ5D) and Saskatchewan Spine Pathway Classification (SSPc). Inter- and intra-rater reliability for SedSign was 73% and 91%, respectively (3 examiners). Results SedSign was positive in 111 (30.2%) and negative in 256 (69.8%) patients. On univariate analysis, a positive SedSign was correlated with age, male sex, several ODI components, EQ5D mobility, cross-sectional area (CSA) of stenosis, antero-posterior diameter of stenosis, and SSPc pattern 4 (intermittent leg dominant pain). On multivariate analysis, SedSign was associated with age, male sex, CSA stenosis and ODI walking distance. Patients with a positive SedSign were more likely to be offered surgery after referral (OR 2.65). The sensitivity and specificity for detecting all types of leg dominant pain were 37.4 and 82.8, respectively (ppv 77.5%, npv 43.8%). Conclusions Patients with a positive SedSign were more likely to be offered surgery, in particular non-instrumented decompression. The SedSign has high specificity for leg dominant pain, but the sensitivity is poor. As such, its use in triaging appropriate surgical referrals is limited. http://link.springer.com/10.1007/s00586-021-06919-9?utm_source=dlvr.it&utm_medium=tumblr http://monchiropracteur.com/

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Sacroiliac joint dysfunction: pathophysiology, diagnosis, and treatment

http://monchiropracteur.com/ monchiropracteur.com Abstract Purpose To review the anatomy and function of the sacroiliac joint (SIJ), as well as the pathophysiology, clinical presentation, diagnostic criteria, and treatment options for SIJ dysfunction. Methods The SIJ serves an extremely crucial function in mobility, stability, and resistance against shear forces. Joint mobility becomes increasingly limited with age-related cartilaginous changes that begin in puberty and continue throughout life. Pain can also be localized to the SIJ itself, known as SIJ dysfunction. A literature review was performed on the anatomy, etiology, risk factors, diagnostic modalities, and treatment options for SIJ dysfunction. Results SIJ dysfunction is an under-recognized source of low back pain. Dysfunction can result from various clinical conditions, as well as abnormal motion or malalignment of the joint. Diagnosis and evaluation of SIJ dysfunction are difficult, with use of physical maneuvers and image-guided anesthetic injection. Non-operative treatment options are considered first-line due to high surgical complication rates. Such options include conservative management, radiofrequency treatment, nerve blocks, and articular injections. Surgical management involves open and percutaneous approaches. Conclusion With the aging nature of the population, SIJ dysfunction has emerged as an extremely prevalent issue. Current research into the pathophysiology and risk factors of SIJ dysfunction is extremely important for planning preventative and therapeutic strategies. Various treatment options exist including conservative management, radiofrequency, nerve blocks, intra-articular or peri-articular injections, and surgical fixation. Improved diagnostic methods in clinical practice are thus critical to properly identify patients suffering from SIJ dysfunction, plan early intervention, and hasten return to function. Level of Evidence I Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding. http://link.springer.com/10.1007/s00586-021-06927-9?utm_source=dlvr.it&utm_medium=tumblr http://monchiropracteur.com/

[monchiropracteur]

Correction to: Evaluation of forward head posture in sitting and standing positions

http://monchiropracteur.com/ monchiropracteur.com http://link.springer.com/10.1007/s00586-021-06923-z?utm_source=dlvr.it&utm_medium=tumblr http://monchiropracteur.com/

[monchiropracteur]

Cervical endplate bone density distribution measured by CT osteoabsorptiometry and direct comparison with mechanical properties of the endplate

http://monchiropracteur.com/ monchiropracteur.com Abstract Purpose Intervertebral device subsidence is one of the complications of anterior cervical discectomy and fusion. The biomechanical properties of vertebral bony endplate may be related to device subsidence. The aim of this study is to measure the cervical endplate bone density distribution using a novel 3D measurement method. Methods Eight human cadaver cervical spines were obtained and levels C3-C7 were dissected and CT scanned. Three-dimensional (3D) CT model was created with the same 3D coordinates of the original DICOM dataset. The regional strength and stiffness of the endplate were determined by indentation testing. The indentation points were recorded by a photograph and the location of the indentation points was projected to the 3D CT model. Three-dimensional coordinates of the indentation point was obtained in the 3D space determined by the DICOM dataset. The area underneath the indentation point was calculated by a trilinear interpolation method directly. Data in HU and correlations with the indentation strength and stiffness were analysed. Results A positive correlation was found between HU and strength (r = 0.52) and between HU and stiffness (r = 0.41). Overall, mechanical strength and stiffness and HU in the superior endplate of the caudal vertebra were lower than those in the inferior endplate of the cranial vertebra in the same intervertebral disc. Conclusions The mechanical properties and the HU were found to be significantly correlated, which employed a novel 3D HU measurement method, thus demonstrating potential to predict cervical endplate failure risk in a clinical setting. http://link.springer.com/10.1007/s00586-021-06920-2?utm_source=dlvr.it&utm_medium=tumblr http://monchiropracteur.com/

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Iatrogenic muscle damage in transforaminal lumbar interbody fusion and adjacent segment degeneration: a comparative finite element analysis of open and minimally invasive surgeries

http://monchiropracteur.com/ monchiropracteur.com Abstract Purpose Lumbar procedures for Transforaminal Lumbar Interbody Fusion (TLIF) range from open (OS) to minimally invasive surgeries (MIS) to preserve paraspinal musculature. We quantify the biomechanics of cross-sectional area (CSA) reduction of paraspinal muscles following TLIF on the adjacent segments. Methods ROM was acquired from a thoracolumbar ribcage finite element (FE) model across each FSU for flexion-extension. A L4-L5 TLIF model was created. The ROM in the TLIF model was used to predict muscle forces via OpenSim. Muscle fiber CSA at L4 and L5 were reduced from 4.8%, 20.7%, and 90% to simulate muscle damage. The predicted muscle forces and ROM were applied to the TLIF model for flexion-extension. Stresses were recorded for each model. Results Increased ROM was present at the cephalad (L3-L4) and L2-L3 level in the TLIF model compared to the intact model. Graded changes in paraspinal muscles were seen, the largest being in the quadratus lumborum and multifidus. Likewise, intradiscal pressures and annulus stresses at the cephalad level increased with increasing CSA reduction. Conclusions CSA reduction during the TLIF procedure can lead to adjacent segment alterations in the spinal element stresses and potential for continued back pain, postoperatively. Therefore, minimally invasive techniques may benefit the patient. http://link.springer.com/10.1007/s00586-021-06909-x?utm_source=dlvr.it&utm_medium=tumblr http://monchiropracteur.com/

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Cross-cultural adaptation of Cantonese (Hong Kong) Oswestry Disability Index version 2.1b

http://monchiropracteur.com/ monchiropracteur.com Abstract Purpose Oswestry Disability Index (ODI) was established by Fairbank in 1989 to assess functional disabilities in low back pain (LBP). It was last updated in 2019 as ODI version 2.1b (ODI AU_2.1b). ODI was first translated into Simplified Chinese Oswestry Disability Index (CODI) in 2008 by Lue. The construct validity, internal consistency, level of agreement and the floor and ceiling effects of CODI were found unclear by Yao in 2016. This study will verify how well the adapted Cantonese–Hong Kong Oswestry Disability Index version 2.1b (HKCODI) aligns with ODI AU_2.1b in the Southern Chinese population. Methods The translation of ODI AU_2.1b was performed according to guidelines from MAPI Research Trust and American Association of Orthopaedic Surgeons. Psychometric properties of HKCODI were tested statistically by Pearson’s correlation, Cronbach’s Alpha and Intraclass  Correlation  Coefficient (ICC). Results A total of 200 subjects (109 males, 91 females) aged from 15 to 85 (mean age = 58.91) with LBP scored from 3/10 to 10/10 in the Visual Analogue Scale (VAS) were recruited in the Occupational Therapy Department of a tertiary referral center. HKCODI demonstrated strong construct validity in comparing with Hong Kong Roland–Morris Disability Questionnaire (HKRMDQ) (r = 0.666, p = 0.000), Short Form Health Survey (SF-36)  Physical Composite Summary (− 0.700, p = 0.000) and VAS (0.487, p = 0.000). Excellent internal consistency and test–retest reliability were confirmed with Cronbach’s Alpha of 0.997 and ICC of 0.993 at 95% confidence level. Conclusion Cross-cultural adaptation of ODI AU_2.1b has been translated and validated as   HKCODI and Item-8 (Sex Life) was suggested to skip for patient older than 60. HKCODI is a fully self-administered and highly reliable tool in assessing the functional disability of patients with LBP in the Southern Chinese population. http://link.springer.com/10.1007/s00586-021-06922-0?utm_source=dlvr.it&utm_medium=tumblr http://monchiropracteur.com/