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lumbar spine - Top 30 Publications

Are shoulder counter rotation and hip shoulder separation angle representative metrics of three-dimensional spinal kinematics in cricket fast bowling?

This study aimed to investigate the relationship between shoulder counter-rotation (SCR), hip shoulder separation (HSS) and three-dimensional spinal kinematics during fast bowling in cricket. Thirty five elite male fast bowlers were analysed using three-dimensional inertial sensors on the spine. Lumbar, thoracic and thoracolumbar kinematics were determined during the delivery stride. Spearman's pairwise correlations displayed significant associations between SCR, thoracic and thoracolumbar lateral flexion between the back foot impact and max contralateral rotation phase of the delivery stride (rs = -.462 and -.460). HSS and thoracolumbar lateral flexion displayed a significant correlation between back foot impact and max contralateral rotation (rs = -.552). No other significant correlations were observed. These results suggest SCR and HSS are modestly related to lateral flexion, leaving a large component of SCR and HSS unrelated to specific three-dimensional spinal kinematics. It is possible that this represents changes in whole spinal orientation and not resultant spinal motion. Despite this, SCR remains the only metric currently related to injury and therefore is important; however it is only a very modest proxy for more traditional descriptions of spinal motion.

Bone mineral density is lower in male than female patients with plaque-type psoriasis in Iran.

There are many similarities with regard to contributing cytokines in patients with psoriasis and osteoporosis. A theory of probable relationship between these two entities has been proposed but there is no concordant consensus. The aim of this study was to evaluate bone mineral density (BMD) in patients with psoriasis.

Monosegmental combined anterior posterior instrumentation for the treatment of a severe lumbar tuberculous spondylodiscitis: case report and literature review.

Spinal tuberculosis (Pott disease) can produce severe deformities when it is not properly treated. Long instrumentations through single or combined double approaches are usually required to prevent and correct the deformity. The authors present a case of severe deformity secondary to tuberculous spondylodiscitis in the lumbar spine treated with a monosegmental instrumentation through a double approach in a patient with idiopathic scoliosis. Deformity correction and infection resolution through debridement and arthrodesis is observed after one year of follow-up.

Effects of Whole-Body Electromyostimulation on Low Back Pain in People with Chronic Unspecific Dorsal Pain: A Meta-Analysis of Individual Patient Data from Randomized Controlled WB-EMS Trials.

In order to evaluate the favorable effect of whole-body electromyostimulation (WB-EMS) on low back pain (LBP), an aspect which is frequently claimed by commercial providers, we performed a meta-analysis of individual patient data. The analysis is based on five of our recently conducted randomized controlled WB-EMS trials with adults 60 years+, all of which applied similar WB-EMS protocols (1.5 sessions/week, bipolar current, 16-25 min/session, 85 Hz, 350 μs, and 4-6 s impulse/4 s impulse-break) and used the same pain questionnaire. From these underlying trials, we included only subjects with frequent-chronic LBP in the present meta-analysis. Study endpoints were pain intensity and frequency at the lumbar spine. In summary, 23 participants of the underlying WB-EMS and 22 subjects of the control groups (CG) were pooled in a joint WB-EMS and CG. At baseline, no group differences with respect to LBP intensity and frequency were observed. Pain intensity improved significantly in the WB-EMS (p < .001) and was maintained (p = .997) in the CG. LBP frequency decreased significantly in the WB-EMS (p < .001) and improved nonsignificantly in the CG (p = .057). Group differences for both LBP parameters were significant (p ≤ .035). We concluded that WB-EMS appears to be an effective training tool for reducing LBP; however, RCTs should further address this issue with more specified study protocols.

Preflight, In-Flight, and Postflight Imaging of the Cervical and Lumbar Spine in Astronauts.

Back pain is a common complaint during spaceflight that is commonly attributed to intervertebral disc swelling in microgravity. Ultrasound (US) represents the only imaging modality on the International Space Station (ISS) to assess its etiology. The present study investigated: 1) The agreement and correlation of spinal US assessments as compared to results of pre- and postflight MRI studies; and 2) the trend in intervertebral disc characteristics over the course of spaceflight to ISS.

Effect evaluation of over 5 year follow up of unilateral pedicle screw fixation with transforaminal lumbar interbody fusion for lumbar degenerative diseases.

To evaluate the clinical effects of over 5 year follow up of unilateral pedicle screw fixation with transforaminal lumbar interbody fusion(TLIF) in treating lumbar degenerative diseases.

Risk factors for the collapse of cemented vertebral bodies after the minimally invasive vertebral augmentation procedures.

To evaluate the incidence rate, the independent factors, and the prevention measures of the collapse of cemented vertebral bodies after minimally invasive vertebral augmentation procedures including percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty(PKP).

Metabolomic pathways to osteoporosis in middle-aged women: A genome-metabolome-wide Mendelian randomization study.

The metabolic state of the body can be a major determinant of bone health. We used a Mendelian Randomization approach to identify metabolites causally associated with bone mass to better understand the biological mechanisms of osteoporosis. We tested bone phenotypes (femoral neck, total hip, and lumbar spine BMD) for association with 280 fasting blood metabolites in 6055 women from TwinsUK cohort with genome-wide genotyping scans. Causal associations between metabolites and bone phenotypes were further assessed in a bidirectional Mendelian Randomization study using genetic markers/scores as instrumental variables. Significant associations were replicated in 624 participants from Hong Kong Osteoporosis Study (HKOS). 15 metabolites showed direct associations with bone phenotypes after adjusting for covariates and multiple testing. Using genetic instruments, 4 of these metabolites were found to be causally associated with hip or spine BMD. These included androsterone sulfate, epiandrosterone sulfate, 5alpha-androstan-3beta17beta-diol disulfate (encoded by CYP3A5), and 4-androsten-3beta17beta-diol disulfate (encoded by SULT2A1). In the HKOS population, all four metabolites showed significant associations with hip and spine BMD in the expected directions. No causal reverse association between BMD and any of the metabolites were found. In the first metabolome-genome-wide Mendelian randomization study of human bone mineral density, we identified 4 novel biomarkers causally associated with BMD. Our findings reveal novel biological pathways involved in the pathogenesis of osteoporosis. This article is protected by copyright. All rights reserved.

Is the Lateral Transpsoas Approach to the Lumbar Spine Safe at L4-L5?

Reproducibility of relaxometry of human lumbar vertebrae at 3 Tesla using 1 H MR spectroscopy.

MR spectroscopy is widely used for fat fraction quantification of human lumbar vertebrae. However, the measurements need to be corrected for relaxation effects.

Research progress of Shenshu (BL 23).

In order to accurately understand the location of Shenshu (BL 23) and to improve the efficacy of acupuncture, a discussion is performed in this paper from aspects of acupoint function, anatomical structure, experiment research, clinical application, etc., hoping to provide benefit for future animal experiments and clinical selection of acupoint. The characteristics of rat spine is different from that of human, and the reliability and authenticity of acupoint location would be compromised if the anatomical characteristics of human was inflexibly applied on animals. "Shenshu" (BL 23) belongs to the bladder meridian of foot taiyang, and is located 1.5 cun lateral to the lower border of the spinous process of the second lumbar vertebra. It is close to kidney, therefore deep insertion or repeated lifting and thrusting of needle would damage kidney and causes acupuncture accident. Therefore, to locate "Shenshu" (BL 23) in rat, the 6th lumbar vertebra is located firstly based on tuber coxae of rat, and then 11th thoracic vertebra is located by upward 4 vertebral bodies or locate 9th to 11th thoracic vertebra which are tight, and finally 2nd lumbar vertebra is located by downward 4 vertebral bodies, and "Shenshu" (BL 23) is 5 mm lateral to it. During clinical treatment, the technique should be gentle; oblique and outward insertion of needle is not allowed; the maximum depth of needle insertion is 1.6 cun (approximately 4.30 cm); the vertical or oblique insertion with needle 45° towards spine is appropriate; the depth of 0.8 to 1.2 cun (2.00 to 3.10 cm) is suitable. In cases of too thin or fat patients, the depth of needle insertion should be adjusted for safety.

Facet-joint injections for non-specific low back pain: a feasibility RCT.

Pain of lumbar facet-joint origin is a common cause of low back pain in adults and may lead to chronic pain and disability, with associated health and socioeconomic implications. The socioeconomic burden includes an inability to return to work resulting in loss of productivity in addition to direct and indirect health-care utilisation costs. Lumbar facet-joints are paired synovial joints between the superior and inferior articular processes of consecutive lumbar vertebrae and between the fifth lumbar vertebra and the sacrum. Facet-joint pain is defined as pain that arises from any structure that is part of the facet-joints, including the fibrous capsule, synovial membrane, hyaline cartilage and bone. This pain may be treated by intra-articular injections with local anaesthetic and steroid, although this treatment is not standardised. At present, there is no definitive research to support the use of targeted lumbar facet-joint injections to manage this pain. Because of the lack of high-quality, robust clinical evidence, the National Institute for Health and Care Excellence (NICE) guidelines on the management of chronic low back pain [NICE. Low Back Pain in Adults: Early Management. Clinical guideline (CG88). London: NICE; 2009] did not recommend the use of spinal injections despite their perceived potential to reduce pain intensity and improve rehabilitation, with NICE calling for further research to be undertaken. The updated guidelines [NICE. Low Back Pain and Sciatica in Over 16s: Assessment and Management. NICE guideline (NG59). London: NICE; 2016] again do not recommend the use of spinal injections.

Muscle Control and Non-specific Chronic Low Back Pain.

Chronic low back pain (CLBP) is the most prevalent of the painful musculoskeletal conditions. CLBP is a heterogeneous condition with many causes and diagnoses, but there are few established therapies with strong evidence of effectiveness (or cost effectiveness). CLBP for which it is not possible to identify any specific cause is often referred to as non-specific chronic LBP (NSCLBP). One type of NSCLBP is continuing and recurrent primarily nociceptive CLBP due to vertebral joint overload subsequent to functional instability of the lumbar spine. This condition may occur due to disruption of the motor control system to the key stabilizing muscles in the lumbar spine, particularly the lumbar multifidus muscle (MF).

Predictors of improvement in bone mineral density after celiac disease diagnosis.

Low bone density is frequently found in patients newly diagnosed with celiac disease (CD), and improvement is variable. This study was performed to assess changes in bone mineral density (BMD) by dual x-ray absorptiometry (DXA) at the lumbar spine, hip, and distal one-third radius as well as clinical predictors of BMD changes after the diagnosis and treatment of CD.

Intraoperative Myelography in Transpsoas Lateral Lumbar Interbody Fusion for Degenerative Lumbar Spinal Stenosis: A Preliminary Prospective Study.

To investigate the feasibility and effectiveness of intraoperative myelography in determining adequacy of indirect spinal canal decompression during transpsoas lateral lumbar interbody fusion (LLIF).

Kyphoplasty for the treatment of an atypical osteoporotic vertebral compression fracture of the lumbar spine: A case report.

Vertebral augmentation is a minimally invasive but sometimes technically challenging intervention typically reserved for the treatment of older patients with painful vertebral compression fractures due to osteoporosis or neoplasms. We report the successful treatment of osteoporotic vertebral compression fractures of the first lumbar vertebral body (L1) using kyphoplasty in a paraplegic young patient with multiple comorbidities. Despite the unusual and complicated clinical scenario, kyphoplasty was nonetheless performed with immediate and lasting pain relief.

Pulsed electromagnetic fields (PEMF) attenuate changes in vertebral bone mass, architecture and strength in ovariectomized mice.

Pulsed electromagnetic fields (PEMF) has been investigated as a noninvasive alternative method to prevent bone loss for postmenopausal osteoporosis (OP), and the bone tissue involved in these studies are usually long bones such as femur and tibia in OP patients or rat models. However, few studies have investigated the effects of PEMF on the vertebral bone in mice with OP. This study aimed to investigate whether PEMF preserve lumbar vertebral bone mass, microarchitecture and strength in ovariectomized (OVX) mouse model of OP and its associated mechanisms. Thirty 3-month-old female BALB/c mice were randomly divided into three groups (n=10): sham-operated control (Sham), ovariectomy (OVX), and ovariectomy with PEMF treatment (OVX+PEMF). The OVX+PEMF group was exposed to 15Hz, 1.6 mT PEMF for 8h/day, 7days/week. After 8weeks, the mice were sacrificed. The OVX+PEMF group showed lower body weight gain of mice induced by estrogen deficiency compared with OVX group. Biochemical analysis of serum demonstrated that serum bone formation markers including bone specific alkaline phosphatase (BALP), serum osteocalcin (OCN), osteoprotegerin (OPG) and N-terminal propeptide of type I procollagen (P1NP) were markedly higher in OVX+PEMF group compared with OVX group. Besides, serum bone resorption markers including tartrate-resistant acid phosphatase 5b (TRAP-5b) and C-terminal crosslinked telopeptides of type I collagen (CTX-I) were markedly lower in OVX+PEMF group compared with OVX group. Biomechanical test observed that OVX+PEMF group showed higher compressive maximum load and stiffness of the lumbar vertebrae compared with OVX group. Micro-computed tomography (μCT) and histological analysis of lumbar vertebrae revealed that PEMF partially prevented OVX-induced decrease of trabecular bone mass and deterioration of trabecular bone microarchitecture in lumbar vertebrae. Real-time PCR showed that the canonical Wnt signaling pathway of the lumbar vertebrae, including Wnt3a, LRP5 and β-catenin were markedly up-regulated in OVX+PEMF group compared with OVX group. Moreover, the mRNA expressions of RANKL and OPG were markedly up-regulated in OVX+PEMF group compared with OVX group, whereas no statistical difference in RANKL/OPG mRNA ratio was found between OVX+PEMF group and OVX group. Besides, our study also found that the RANK mRNA expression was down-regulated in OVX+PEMF group compared with OVX group. Taken together, we reported that long-term stimulation with PEMF treatment was able to alleviate lumbar vertebral OP in postmenopausal mice through a combination of increased bone formation and suppressed bone resorption related to regulating the skeletal gene expressions of Wnt3a/LRP5/β-catenin and OPG/RANKL/RANK signaling pathways.

Bone Morphogenetic Proteins Usage in Anterior Lumbar Inter-Body Fusion: What Else Can Go Wrong?

Bone Morphogenetic Protein (BMP) graft showed promising outcome during early phases of its use. However unreported adverse events and off label use shattered its safe profile and raised concerns regarding its indication. In 2008, the Food and Drug Administration (FDA) prohibited its use in anterior cervical spine procedures due to possibility of edema, hematoma and need of intubation. At the molecular level, BMP act as multifactorial growth factors playing a role in cartilage, heart, and bone formation. However its unfavorable effect on bone overgrowth or heterotopic ossification post spine surgeries has been described. Reported cases in literature were limited to epidural bone formation.

An unusual case of ureteral perforation in minimally invasive pedicle screw instrumentation and review of the literature.

and Importance: Injury of the ureter is a potentially devastating complication most often reported in gynecologic, colorectal, vascular pelvic surgery or endoscopic procedures for ureteric pathologies. We report a rare case of ureteral rupture occurring as a complication of percutaneous pedicle screw placement.

Development and Validation of Prediction Equations for Spinal Curve Angles Based on Skin Surface Measurements.

The purpose of this study was to develop, assess the reliability of, and validate prediction equations that estimate the sagittal curves of the spine from the skin surface.

The Reliability of Standing Sagittal Measurements of Spinal Curvature and Range of Motion in Older Women With and Without Hyperkyphosis Using a Skin-Surface Device.

The purpose of this study was to investigate the intrarater reliability of a skin-surface instrument (Spinal Mouse, Idiag, Voletswil, Switzerland) in measuring standing sagittal curvature and global mobility of the spine in older women with and without hyperkyphosis.

A subject-specific biomechanical control model for the prediction of cervical spine muscle forces.

The aim of the present study is to propose a subject-specific biomechanical control model for the estimation of active cervical spine muscle forces.

Major destructive asymptomatic lumbar Charcot lesion treated with three column resection and short segment reconstruction. Case report, treatment strategy and review of literature.

Charcot's spine is a long-term complication of spinal cord injury. The lesion is often localized at the caudal end of long fusion constructs and distal to the level of paraplegia. However, cases are rare and the literature relevant to the management of Charcot's arthropathy is limited. This paper reviews the clinical features, diagnosis, and surgical management of post-traumatic spinal neuroarthropathy in the current literature. We present a rare case of adjacent level Charcot's lesion of the lumbar spine in a paraplegic patient, primarily treated for traumatic spinal cord lesion 39 years before current surgery. We have performed end-to-end apposition of bone after 3 column resection of the lesion, 3D correction of the deformity, and posterior instrumentation using a four-rod construct. Although the natural course of the disease remains unclear, surgery is always favorable and remains the primary treatment modality. Posterior long-segment spinal fusion with a four-rod construct is the mainstay of treatment to prevent further morbidity. Our technique eliminated the need for more extensive anterior surgery while preserving distal motion.

A Network Meta-Analysis on the Short-Term Efficacy and Adverse Events of Different Anti-Osteoporosis Drugs for the Treatment of Postmenopausal Osteoporosis.

A network meta-analysis was conducted to compare the short-term efficacy and adverse events of different drugs for the treatment of postmenopausal osteoporosis (PMO), providing a more effective treatment for PMO. We initially searched through various databases like PubMed, Cochrane Library and EMBASE from inception till October 2016. All randomized controlled trials (RCTs) of drugs for the treatment of PMO were included for direct and indirect comparison. A combination of direct and indirect evidence of different inhibitors of antidiabetic drugs for treatment of PMO were considered for calculating the weighted mean difference (WMD) value or odd ratio (OR) value and to draw surface under the cumulative ranking (SUCRA) curves. Twenty-seven RCTs were ultimately incorporated into this network meta-analysis comprising of 48,200 patients suffering from PMO. The network meta-analysis revealed that compared with placebo, alendronate had better efficacy on improving bone mineral density (BMD) at lumbar spine, femoral neck and total hip. Risedronate and raloxifene had relatively lower incidence of new vertebral fractures. The SUCRA analysis showed that alendronate had better efficacy on improving BMD, risedronate could significantly decrease the incidence of fresh fracture and bazedoxifene was relatively safe. The available evidence suggested that alendronate and risedronate might be the superior choices for the treatment of PMO, while bazedoxifene was a comparatively safer option for patients. This article is protected by copyright. All rights reserved.

Analysis of intra and extra-myocellular lipids in the multifidus muscle in patients with chronic low back pain using MR spectroscopy.

To analyze the intra (IMCL) and extra-myocellular lipids (EMCL) concentration in the multifidus muscle (Mm) using MR spectroscopy (MRS) in patients with low back pain (LBP), and to evaluate the correlation between those lipid concentrations and age, obesity, atrophy of the Mm and LBP intensity.

Quantitative Postural Analysis of Children With Congenital Visual Impairment.

The aim of this study was to compare the postural alignment of children with visual impairment with that of children without visual impairment.

Review article: Methodology for the 'rapid review' series on musculoskeletal injuries in the emergency department.

Musculoskeletal injuries are a common presentation to the ED, with significant costs involved in the management of these injuries, variances in care within the ED and associated morbidity. A series of rapid review papers were completed to guide best practice for the assessment and management of common musculoskeletal injuries presenting to the ED. This paper presents the methodology used across the rapid reviews. PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites, were searched in 2015. The search was repeated consistently for each topic area (injuries of the foot and ankle, knee, hand and wrist, elbow, shoulder, lumbar spine and cervical spine). English-language primary studies, systematic reviews and guidelines that were published in the last 10 years and addressed acute musculoskeletal injury management were considered for inclusion. Data extraction of each included article was conducted, followed by a quality appraisal. The extracted data from each article was synthesised to group similar evidence together. For each rapid review, the evidence has been organised in a way that a clinician can direct their attention to a specific component of the clinical cycle of care in the ED, such as the assessment, diagnostic tests, management and follow-up considerations from ED. The series of rapid reviews are designed to foster evidence-based practice within the ED, targeting the injuries most commonly presenting. The reviews provide clinicians in EDs with rapid access to the best current evidence, which has been synthesised and organised to assist decision-making.

Spontaneous spinal arthordesis in Stand-Alone Percutaneous Pedicle Screw Fixation without in situ fusion in patients with lumbar segmental instability: long term clinical, radiologic and functional outcome.

No study to date has established how commonly spontaneous fusion occurs after stand-alone percutaneous pedicle screw fixation in adult population.

Effect of smoking status on successful arthrodesis, clinical outcome and complications after anterior lumbar interbody fusion (ALIF).

Anterior lumbar interbody fusion (ALIF) is a surgical technique indicated for the treatment of several lumbar pathologies. Smoking has been suggested as a possible cause of reduced fusion rates following ALIF, though the literature regarding the impact of smoking status on lumbar spine surgery is not well established. This study aims to assess the impact of perioperative smoking status on the rates of perioperative complications, fusion and adverse clinical outcomes in patients undergoing ALIF surgery.

Risk factors analysis for foot drop associated with lumbar disc herniation: an analysis of 236 patients.