Lumbar Mobility Research Articles

Lowest instrumented vertebra selection in Lenke 3C and 6C scoliosis: what if we choose lumbar apical vertebra as distal fusion end?

The aim of this study was to investigate whether or not post-op curve behaviour differs due to different choices of lowest instrumented vertebra (LIV) with reference to lumbar apical vertebra (LAV) in Lenke 3C and 6C scoliosis. We reviewed all the AIS cases surgically treated in our institution from 2002 through 2008. Inclusion criteria were as follows: (1) patients with Lenke 3C or 6C scoliosis who were treated with posterior pedicle screw-only constructs; (2) 2-year radiographic follow-up. All the included patients were categorized into three groups based on the relative position of LIV and LAV: Group A-the LIV was above the LAV; Group B-the LIV was at the LAV; Group C-the LIV was below the LAV. All the radiographic parameters were then compared among the groups. All image data were available in our picture archiving and communication systems. Standing anteroposterior (AP) and lateral digital radiographs were reviewed at four times (pre-op, post-op, 3-month and 2-year). In each standing AP radiograph, centre sacral vertical line (CSVL, the vertical line that bisects the proximal sacrum) was first drawn, followed by measuring T1-CSVL, LIV-CSVL, (LIV+1)-CSVL, LAV-CSVL and thoracic AV-CSVL distance. In addition, the Cobb angles of major thoracic and lumbar curves were measured at the four times and the correction rates were then calculated. Of the 278 patients reviewed, 40 met the inclusion criteria; 11 of these were included in Group A (LIV above LAV), another 11 in Group B (LIV at LAV) and the remaining 18 in Group C (LIV below LAV). At 2-year follow-up, the lumbar vertebrae such as LIV, LIV+1 and LAV were all more deviated than before surgery in Group A (LIV above LAV), whereas in Group B and C (LIV at and below LAV) they were all less deviated than before surgery. No significant differences were found in thoracic or lumbar correction rate, global coronal balance and incidence rate of trunk shift among the three groups. In conclusion, in Lenke 3C and 6C scoliosis, post-op lumbar curve behaviour differs due to different choices of LIV with reference to LAV, that is, the deviation of lumbar curve improves when the LIV is either at or below the LAV but deteriorates when the LIV is above the LAV. Although the greatest correction occurs when the LIV is below the LAV, choosing LAV as LIV can still be the optimal option in certain cases, since it can yield similar correction while preserving more lumbar mobility and growth potential.

Learning Lumbar Spine Mobilization: The Effects of Frequency and Self-Control of Feedback

Controlled laboratory study, longitudinal. To investigate the effects of frequency and self-control of feedback on physiotherapy students learning lumbar spinal mobilization. Posterior-to-anterior mobilization is included in most physiotherapy curricula. However, force application varies between therapists and the optimal feedback for learning is unknown. Sixty-two physiotherapy students were randomized to 3 feedback groups: constant (100% of practice trials), intermittent (33%), and self-controlled (varied according to student choice) feedback. Students performed 12 practice trials of grade II posterior-to-anterior mobilization to the third lumbar vertebra while receiving real-time feedback. The differences between students' force parameters (mean peak force [N], force amplitude [N], and oscillation frequency [Hz]) and those of a physiotherapist expert were compared between groups posttest and at a follow-up of 5 to 7 days using analysis of covariance. Students completed a survey regarding their perceptions of feedback. Students in the self-controlled group applied mean peak force (mean difference between student and expert, 6.7 N; 95% confidence interval [CI]: 4.4, 9.0) and force amplitude (6.3 N; 95% CI: 4.2, 8.4) that more closely matched the expert's than those applied by the constant group (13.7 N; 95% CI: 8.7, 18.6; P = .021, and 13.1 N; 95% CI: 8.9, 17.4; P = .028) at posttest, with similar results at follow-up for force amplitude only (self-controlled, 9.5 N; 95% CI: 5.8, 18.1; constant, 21.0 N; 95% CI: 13.3, 28.7; P = .018). There were no other significant differences. All students reported a better understanding of manual force application, but feedback preferences varied. Self-controlled feedback appears to be more beneficial than constant feedback for students learning to apply forces during lumbar mobilization.

New vertebral and rib material point to modern bauplan of the Nariokotome Homo erectus skeleton

The double S shape of the vertebral column is one of the most important evolutionary adaptations to human bipedal locomotion, providing an optimal compromise between stability and mobility. It is commonly believed that a six element long lumbar spine facilitated the critical adoption of lumbar lordosis in early hominins, which contrasts with five lumbars in modern humans and four in chimpanzees and gorillas. This is mainly based on the juvenile Homo erectus skeleton KNM-WT 15000 from Nariokotome, Kenya. Yet, the biomechanical advantage of a long lumbar spine is speculative. Here we present new vertebral and rib fragments of KNM-WT 15000. They demonstrate that the sixth to the last presacral vertebra possesses rib facets and therefore indicate the presence of only five lumbar and twelve thoracic segments, as is characteristic of modern humans. Moreover, they show that no additional element was located between the sixth to the last presacral vertebra and Th11 as suggested in the original description. The transition from thoracic to lumbar type orientation of the facet joints that takes place at Th11 is thus at the same segment as in over 40% of modern humans, suggesting an identical lumbar mobility and capacity for lordosis. Taken together, KNM-WT 15000 had one vertebra less than previously thought irrespective of whether rib-free lumbar vertebrae or vertebrae that bear lumbar-like articular processes are counted. Furthermore, the new rib fragments imply a rearrangement of the ribs that results in a symmetrical rib cage. This challenges previous claims for idiopathic or congenital scoliosis. We conclude that the bauplan of the hominin axial skeleton is more conservative than previously thought.

Biomechanical measures of knee joint mobilization

Background and purpose: The purpose of this study was to quantify the biomechanical properties of specific manual therapy techniques in patients with symptomatic knee osteoarthritis.Methods: Twenty subjects (7 female/13 male, age 54±8 years, ht 1·7±0·1 m, wt 94·2±21·8 kg) participated in this study. One physical therapist delivered joint mobilizations (tibiofemoral extension and flexion; patellofemoral medial–lateral and inferior glide) at two grades (Maitland’s grade III and grade IV). A capacitance-based pressure mat was used to capture biomechanical characteristics of force and frequency during 2 trials of 15 second mobilizations. Statistical analysis included intraclass correlation coefficient (ICC3,1) for intrarater reliability and 2×4 repeated measures analyses of variance and post-hoc comparison tests.Results: Force (Newtons) measurements (mean, max.) for grade III were: extension 45, 74; flexion 39, 61; medial–lateral glide 20, 34; inferior glide 16, 27. Force (Newtons) measurements (mean, max.) for grade IV were: extension 57, 76; flexion 47, 68; medial–lateral glide 23, 36; inferior glide 18, 35. Frequency (Hz) measurements were between 0·9 and 1·2 for grade III, and between 2·1 and 2·4 for grade IV. ICCs were above 0·90 for almost all measures.Discussion and conclusion: Maximum force measures were between the ranges reported for cervical and lumbar mobilization at similar grades. Mean force measures were greater at grade IV than III. Oscillation frequency and peak-to-peak amplitude measures were consistent with the grade performed (i.e. greater frequency at grade IV, greater peak-to-peak amplitude at grade III). Intrarater reliability for force, peak-to-peak amplitude and oscillation frequency for knee joint mobilizations was excellent.

Describing and predicting the effectiveness of physical therapy in treatment of lumbar disc herniation using a logistic curve model

Objective To establish a mathematical model for describing and predicting the effectiveness of physical therapy on lumbar disc hernation(LDH).Methods Daily comprehensive physical therapy interventions including lumbar traction,mobilization and physical agents were administered to 31 LDH patients for 10 sessions.A visual analogue scale was used to measure the pain intensity before each session.The logistic curve model was used in the regression analysis.The first 2 to 9 pain measurements were involved in different predictive models,and the predictive results were compared among different models.Results In regression analysis,the global R2 was 0.719.In predicting analysis,the more measurements involved in the predictive model,the more effective the prediction.The predictive power was low when the model included less than 4 measurements.the prediction power was high when more than 5 measurements were used in the model.Conclusion The logistic model can describe and predict the effectiveness of multiple physical therapy on LDH patients. Key words: Lumber disc hernation; Physical therapy; Pain measurement; Logistic model; Prediction

Kinematic evaluation of the adjacent segments after lumbar instrumented surgery: a comparison between rigid fusion and dynamic non-fusion stabilization

The aim of the current study was to evaluate changes in lumbar kinematics after lumbar monosegmental instrumented surgery with rigid fusion and dynamic non-fusion stabilization. A total of 77 lumbar spinal stenosis patients with L4 degenerative spondylolisthesis underwent L4-5 monosegmental posterior instrumented surgery. Of these, 36 patients were treated with rigid fusion (transforaminal lumbar interbody fusion) and 41 with dynamic stabilization [segmental spinal correction system (SSCS)]. Lumbar kinematics was evaluated with functional radiographs preoperatively and at final follow-up postoperatively. We defined the contribution of each segmental mobility to the total lumbar mobility as the percent segmental mobility [(sagittal angular motion of each segment in degrees)/(total sagittal angular motion in degrees) × 100]. Magnetic resonance imaging was performed on all patients preoperatively and at final follow-up postoperatively. The discs were classified into five grades based on the previously reported system. We defined the progress of disc degeneration as (grade at final follow-up) - (grade at preoperatively). No significant kinematical differences were shown at any of the lumbar segments preoperatively; however, significant differences were observed at the L2-3, L4-5, and L5-S1 segments postoperatively between the groups. At final follow-up, all of the lumbar segments with rigid fusion demonstrated significantly greater disc degeneration than those with dynamic stabilization. Our results suggest that the SSCS preserved 14% of the kinematical operations at the instrumented segment. The SSCS may prevent excessive effects on adjacent segmental kinematics and may prevent the incidence of adjacent segment disorder.

Changes in Bending Stiffness and Lumbar Spine Range of Movement Following Lumbar Mobilization and Manipulation

Objective The purpose of this study was to investigate the effects of lumbar rotational manipulation and lumbar central posteroanterior mobilization on lumbar bending stiffness and flexion and extension range of motion (ROM). Methods A same-subject, repeated-measures, crossover design was used using 32 asymptomatic subjects (16 female and 16 male; mean [SD] age, 25.5 [4.5] years; weight, 65.7 [11.8] kg; and height, 1.70 [0.08] m). Each subject received mobilization or manipulation on 2 different occasions. Bending stiffness was calculated using a 3-point bending model using an electromagnetic tracking device and a force platform; lumbar flexion and extension ROM was measured using an electromagnetic tracking device. All variables were measured pre- and postintervention. Their effect was compared using paired t tests. Results Manipulation and mobilization did not significantly alter either bending stiffness or lumbar flexion and extension ROM (mobilization: P = .175, P = .613, and P = .535; manipulation: P = .973, P = .323, and P = .439). Bending stiffness changes were not correlated to changes in ROM (Pearson r for stiffness-flexion = −0.102, P = .586; Pearson r for stiffness-extension = 0.014, P = .941). Conclusions Manipulation and mobilization had no significant effect on bending stiffness or flexion and extension ROM for this group of subjects. Some individual variations in effect were observed.

Non secreting multiple mieloma

We present the case of a 70-year-old woman with no history of interest who had suffered rib pain of 8 months evolution during the day and night with progressive intensity, accompanied by a weight loss of 8 kg in the previous 4 months. Examination revealed a marked decrease in lumbar mobility with intense pain in the chondrosternal joints and knees upon palpation. Haemogram and biochemical analysis were normal. ESR: 16 mm/1st h. Immunoglobulins: IgG 649 mg/dl (690-1400), IgA 118 mg/ dl (70-370), IgM 32.8 mg/dl (40-240), IgD <23.3 IU/ml (0-100), IgE 29.5 IU/ml (0-100). Total Protein: 7.1 g/dl. Serum protein (%): 61.9 albumin, a1 globulins 4.5, a2 globulins 12.4, b globulins 12.4 and γ globulin 8.8. Immunoelectrophoresis: blood: Kappa chains 180 mg/ dl (200-440), Lambda chains 92.7 mg/dl (110-240); urine: Kappa chains 6.7 mg/dl, Lambda chains <0.39 mg/dl; conservation of the IgG, IgA and IgM precipitation arc, balance of light chains in serum with minimal urinary excretion. A simple X-ray showed osteolytic lesions without sclerotic borders of different sizes and without cortical destruction on femurs (Figure 1), humeri (Figure 2), rib cage, clavicles and skull (Figure 3), and with no uptake upon scintigraphy (Tc99).

Análisis tridimensional del movimiento de la columna lumbar en sujetos normales y pacientes con lumbalgia crónica

Introduction Accurate measurement of lumbar spine mobility can help to assess the severity of a low back pain, monitoring its course and evaluating treatment effectivity. The results obtained with the Inclinometer and 3D Movement Analysis (optoelectronic) in a group of patients and controls are presented to evaluate the differences with both techniques between both populations. Material and methods A total of 47 subjects with chronic low back pain and 33 healthy controls were studied using both the Double Inclinometer technique and 3D Movement Analysis of the lumbar spine. Measurements were obtained in a single session of flexion, extension, right and left lateral flexions and flexion velocity. Results Range of motion was greater in men than in women in all directions of movement, however, based on the analysis of the variance, the differences were not statistically significant ( p>0.05). Mean values were significantly higher in all variables in healthy subjects (flexion p=0.0001; extension p=0.05; R lateral flexion p=0.0027; L lateral flexion, p=0.0002; flexion velocity p=0.00001). Cutoff values for each variable are shown, indicating their sensitivity and specificity. Discussion and conclusions In the population studied by 3D Movement Analysis, lumbar mobility was similar en both genders, however, larger samples are needed to confirm these data. The main conclusion of the study is that this technique has excellent capacity to discriminate patients suffering chronic lumbar pain from the normal population. While restriction of motion is a well-known fact, the overwhelming statistical evidence and the normative data presented show that motion analysis is an excellent tool in the diagnosis of chronic low back pain, that is especially useful appears the velocity of flexion.

Immediate Effects of Adding a Sciatic Nerve Slider Technique on Lumbar and Lower Quadrant Mobility in Soccer Players: A Pilot Study

The objective of this study was to assess the immediate effect of a sciatic nerve slider technique added to sustained hamstring stretching on lumbar and lower quadrant flexibility. This was a randomized controlled pilot study. Eight (8) healthy male soccer players (21 +/- 3 years) were randomly assigned to 2 groups. Group A received 5 minutes of bilateral sustained hamstring stretching. Group B additionally received 60 seconds of a sciatic nerve slider technique for each leg. Pre- and postintervention outcomes taken by an assessor blinded to the treatment allocation of the participants included metric distance on finger-to-floor, sit and reach, and the modified Schöber tests and goniometric range of each hip for the straight-leg raise and each knee for seated slump test. Baseline between-group differences were examined with an independent t test and a two-way repeated-measures analysis of variance with p < 0.05 and p < 0.025 analyzed effects of the interventions. There were no significant between-group baseline differences (p > 0.2). There was a significant effect for time on all outcomes (p < 0.01) other than the sit and reach test (p = 0.8). A significant interaction between group . time with greater improvements in group B was found for the modified Schöber test (F = 5.5; p < 0.05), left straight-leg raise (F = 6.1; p < 0.05) and slump test in either leg (left F = 28.7; p = 0.002; right F = 4.9; p < 0.05). Adding a sciatic nerve slider technique to sustained hamstring stretching led to greater immediate increases in both lumbar and lower quadrant flexibility in young healthy soccer players as measured by four of the seven outcomes used. Study limitations and suggestions for future studies are discussed.

Application of a classification system and description of a combined manual therapy intervention: a case with low back related leg pain

Low back pain and leg pain commonly occur together. Multiple factors can cause low back related leg pain; therefore, identification of the source of symptoms is required in order to develop an appropriate intervention program. The patient in this case presented with low back and leg pain. A patho-mechanism based classification is described in combination with the patient's subjective and objective examination findings to guide treatment. The patient's symptoms improved marginally with intervention addressing primarily the musculoskeletal impairments and with intervention addressing primarily the neurodynamic impairments. Full functional improvements were attained with a manual therapy intervention directed at both mechanisms simultaneously. The approach described in this case address a mixed pathology utilizing passive accessory and passive physiological lumbar mobilizations in combination with lower extremity neurodynamic mobilization. The patient reported complete resolution of symptoms after a total of seven visits over a period of 6 weeks. While specific guidelines do not yet exist for treatment based on the classification approach utilized, this case report provides an example of manual therapy to address low back related leg pain of mixed pathology.

The evaluation of deficits on dynamic postural sway control and its correlation with lumbar mobility in females with chronic low back pain

Introduction: Previous studies on chronic low back pain (CLBP) have addressed the biomechanical performance of trunk, including its mobility, and the static balance performance in the related population. However, the onset of low back pain is commonly linked with dynamic activities and therefore, the evaluation of the balance performance in dynamic condition would be clinically important. The objectives of this study were to assess the dynamic postural control and its relationship with trunk mobility in chronic low back pain patients. Materials and Methods: Twenty-four female patients with chronic low back pain and 24 able-bodied females, all between 25 to 45 years old, voluntarily participated in this study. Dynamic postural control, lumbar mobility and back pain were measured by a Biodex system, Schober technique and Quebec questionnaire, respectively. Multivariate analysis of variance (repeated measure) and Pearson correlation coefficient were used for data analysis (α < 0.05). Results: Chronic low back pain patients had greater dynamic postural sway (P < 0.0001). In chronic low back pain, the function of lower limbs and the trunk’s proprioception were affected. This deficit was better observed in closed eyes condition. Lumbar mobility was significantly reduced in chronic low back pain group, However there was no significant relationship between the lumbar mobility and the postural control (P < 0.001). Conclusion: Chronic low back pain is associated with greater postural sway and reduced lumbar mobility. These variables are independent and should be considered in both detection and treatment process separately. More studies are sequined to determine if these parameters are primary or secondary

Painful shoulder in ulcerative colitis

Acupotomy aims to reduce pressure on the nerve, improve surrounding blood circulation, and recover the kinetic state of soft tissue in treating lumbar disc herniation. Although several previous studies have suggested the potential use and substantial benefits of acupotomy, there is still insufficient evidence regarding this technique. This trial is designed to determine if acupotomy is more effective than manual acupuncture in improving low back pain and/or leg pain, disability, lumbar mobility, and quality of life in patients with herniated lumbar disc.Fifty eligible patients will be randomly assigned to an acupotomy group or a manual acupuncture group in a 1:1 ratio. The experimental group will receive acupotomy at the affected side’s inner core muscles and soft tissue at the level of the herniated disc where tenderness appears (twice per week for 2 weeks). The control group will receive manual acupuncture (thrice per week for 2 weeks) at GV3 (Yaoyangguan) and the bilateral BL23 (Shenshu), BL24 (Qihaishu), BL25 (Dachangshu), and BL26 (guanyuanshu) for local points and the bilateral GB30 (Huantio), BL40 (Weizhong), and BL60 (Kunlun) for distant points. The primary outcome will be the mean change in the visual analog scale from baseline to 4 weeks (2 weeks after final treatment). The Oswestry Disability Index, Modified-Modified Schober Test, and EuroQol five dimensions questionnaire will determine secondary outcomes. Adverse events will be evaluated at every visit.This study will provide valuable data and insights for a confirmative, full-scale randomized controlled trial to determine the clinical effects of acupotomy.

A stiff and straight back preoperatively is associated with a good outcome 2 years after lumbar disc surgery

Background and purpose The degree of lumbar lordosis and reduced lumbar mobility are regarded as important clinical features in patients with low back pain, and in lumbar disc herniation A more stiff back preoperatively in a proportion of patients has been shown to be associated with sequestered disc herniation. The main aim of this study was to investigate whether there was any correlation between lumbar lordosis and flexion on the one hand in patients with lumbar disc herniation who were scheduled for surgery, and postoperative pain and disability on the other. Our second aim was to determine the patterns of postoperative improvement in pain, perceived disability, and flexion/lordosis for 2 years after surgery.Methods Pain (VAS), disability (DRI), lumbar flexion and lordosis (Debrunner's kyfometer) were measured pre- and postoperatively in 80 patients who underwent microscopic lumbar disc surgery.Results Patients with preoperative hyperlordosis had more severe pain and more disability postoperatively than patients with hypolordosis. The level of pain did not change much from 2–6 weeks postoperatively until 2 years, while the perceived disability did not reach a steady state until 6 months after surgery.Interpretation Patients with a stiff and flat back have a good prognosis after lumbar disc surgery, and in most cases the pain will reach the 2-year level during the first 2–6 weeks, while the physical restoration measured by the lumbar flexion and lordosis, and the perceived disability, will continue to improve over the first 6 months after surgery.

An investigation into the potential hypoalgesic effects of different amplitudes of PA mobilisations on the lumbar spine as measured by pressure pain thresholds (PPT)

Mobilisation of the spine is a common technique used in clinical practice. Studies have shown that mobilisation to the spine can decrease pain. The optimum treatment dose for achieving this has not so far been investigated. Previous studies that demonstrate the pain relieving effects of mobilisations have used large amplitude of oscillations. The importance of amplitude on pain relief has not been established. The current study aims to: a) Investigate the importance of amplitude as part of the treatment dose. b) To explore the extent of any pain reliving effects seen following mobilisations. The study employed a randomised, single blind, within-subjects repeated measure design. Thirty asymptomatic subjects participated. The subjects completed three experimental conditions on three separate occasions. The conditions were: large amplitude of oscillations (forces between 50 and 200 N), small amplitude of oscillations (150 N–200 N) and quasi-static (maintained at 200 N). Each condition involved a 3x1 minute central PA mobilisation at a frequency of 1.5 Hz on the lumbar spine. Pressure pain thresholds (PPT) were measured immediately before and after each intervention at 4 different sites. The sites were chosen to determine the extent of the hypoalgesic response. Results demonstrated a significant increase in PPT following lumbar mobilisations ( p = 0.013) at all measured sites. However, no significant difference was found between amplitude conditions ( p = 0.864). This study suggests that in asymptomatic subjects a systemic hypoalgesic response is caused by lumbar mobilisation regardless of amplitude.

Atividade física regular preserva a função pulmonar em pacientes com espondilite anquilosante sem doença pulmonar prévia

Ankylosing spondylitis is an inflammatory condition which causes restriction in the lung function due to column joint alterations leading to postural dysfunction and thoracic ciphosis. OBJECTIVE: The objective of this study was to evaluate the lung function in patients with ankylosing spondylitis and to associate this parameter with physical activity. METHODS:104 patients were selected and only 15 fulfilled inclusion and exclusion criteria. They were divided in two groups: group I composed by sedentary patients, and group II with patients that has a regular physical activity. Demographic features, parameters of cervical, dorsal and lumbar column mobility were collected. Measurements of minute volume, respiratory rate, maximum inspiratory and expiratory pressures and quality of life (HAQ-S) were also evaluated. RESULTS: Both groups were similar regarding mean age (49.6 ± 1.6 vs. 43.3 ± 13.2 years, p = 0.19), weight (70.9 ± 9.7 vs. 74.1 ± 12.1 kg, p = 0.30) and height (164.6 ± 3.5 vs. 167.6 ± 6.9 cm, p = 0.16). However, the mean disease duration was significantly higher in the group I compared to the active group (20.1 ± 6.9 vs. 9.6 ± 3.4 years, p = 0.004). Interestingly, a significantly higher minute volume was observed in the active group than inactive one (4.83 ± 1.07 vs. 6.1 ± 1.25 L/min, p = 0.035). On the other hand, no differences were found regarding respiratory rate (14.57 ± 1.76 vs. 16.25 ± 3.53 ipm, p = 0.15), tidal volume (0.402 ± 0.07 vs. 0.342 ± 0.10 L, p = 0.13), as well as maximum inspiratory pressure (84.29 ± 24.99 vs. 93.13 ± 16.76 cmH2O), p = 0.24) and maximum expiratory pressure (102.2 ± 29.26 vs. 105 ± 17.32 cmH2O, p = 0.42). ), CONCLUSION: This study seems to show that respiratory volumes are maintained stable in patients with ankylosing spondylitis that are under regular physical activity.

GRAPPA at the European League Against Rheumatism (EULAR) 2008

Launched in the summer of 2003, the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) is a nonprofit organization committed to advancing research and understanding of the assessment and treatment of psoriasis and psoriatic arthritis (PsA). This effort meets the need of helping rheumatologists recognize skin symptoms and helping dermatologists recognize joint symptoms for earlier diagnosis and more appropriate treatment of this disease, which affects millions of people throughout the world. GRAPPA members meet several times a year to discuss issues relevant to the organization’s objectives. There are 2 meetings a year adjacent to major rheumatology meetings: the American College of Rheumatology (ACR), which takes place in North America, and the European League Against Rheumatism (EULAR), which takes place in Europe; and adjacent to major dermatology meetings: the American Academy of Dermatology (AAD) in North America and the European Academy for Dermatology and Venereology (EADV) in Europe. Our report summarizes the recent GRAPPA meeting at EULAR, June 11, 2008, at the Paris Convention Center. This meeting was dedicated to defining psoriatic spondylitis. The prevalence of spinal involvement in patients with PsA has varied from 25% to 70%1. The wide variation is due to the lack of a common definition for psoriatic spondylitis. The agenda included presentations by a number of GRAPPA members followed by breakout groups and discussion. Philip Helliwell, of Leeds, UK, presented the background and issues to be addressed by the group. He pointed out that there have been 2 general approaches to the diagnosis of psoriatic spondylitis. One uses the criteria for ankylosing spondylitis (AS), which rely on the presence of signs and symptoms of inflammatory back pain and limitation of lumbar mobility as well as the presence of either bilateral grade 2 or unilateral grade 3 or 4 sacroiliitis. The other …

Artificial nucleus replacement: surgical and clinical experience

Objective: To assess long-term clinical results of prosthetic disc nucleus (PDN) replacement for the treatment of lumbar disc herniation. Methods: Seventy-two patients with lumbar disc herniation were implanted with a single PDN device from March 2002 to December 2003. Fifty-eight (80.6%) patients attended clinical, functional, and radiographic follow-up examinations for more than 48 months. Independent analysis was performed by careful review of the interviews, operative reports, preoperative and postoperative radiographs, and computed tomography scans or magnetic resonance imaging (MRI). Results: After implantation, a significant proportion of patients experienced pain relief. Improvements were noted in pain intensity, walking distance, neurological weakness, Oswestry and Prolo scores, intervertebral disc height and lumbar mobility. Intervertebral disc height was not well maintained, compared with the preoperative height it decreased 18% (P < 0.001). Several complications were associated with the implantation of PDN, including transient low-back pain, implant dislocation, malposition of the implant, damage to the end plates and subsidence of implant. Conclusion: The clinical data show that PDN is preferred and can effectively increase the range of lumbar motion in patients with lumbar disc herniation. However, this study only represents cases in our centre.

Artificial nucleus replacement: surgical and clinical experience

To assess long-term clinical results of prosthetic disc nucleus (PDN) replacement for the treatment of lumbar disc herniation. Seventy-two patients with lumbar disc herniation were implanted with a single PDN device from March 2002 to December 2003. Fifty-eight (80.6%) patients attended clinical, functional, and radiographic follow-up examinations for more than 48 months. Independent analysis was performed by careful review of the interviews, operative reports, preoperative and postoperative radiographs, and computed tomography scans or magnetic resonance imaging (MRI). After implantation, a significant proportion of patients experienced pain relief. Improvements were noted in pain intensity, walking distance, neurological weakness, Oswestry and Prolo scores, intervertebral disc height and lumbar mobility. Intervertebral disc height was not well maintained, compared with the preoperative height it decreased 18% (P < 0.001). Several complications were associated with the implantation of PDN, including transient low-back pain, implant dislocation, malposition of the implant, damage to the end plates and subsidence of implant. The clinical data show that PDN is preferred and can effectively increase the range of lumbar motion in patients with lumbar disc herniation. However, this study only represents cases in our centre.

The Efficacy of Physical Therapy and Physical Therapy Plus Calcitonin in the Treatment of Lumbar Spinal Stenosis

PurposeThe aim of our study was to compare the efficacy of physical therapy alone and in combination with calcitonin in patients with neurogenic claudication (NC).Materials and MethodsIn this single blind, and randomized study, patients with lumbar spinal canal stenosis who were diagnosed by clinical findings and MRI and having NC were included. Patients were observed for 8 weeks and evaluated before and after treatment. Patients were randomized between the salmon calcitonin 200 U/day + physical therapy (n = 23) (Group 1) and paracetamol 1,500 mg/day + physical therapy (n = 22) (Group 2) treatment groups. Both groups received the same physical therapy (interferential current + hot pack + short wave diathermy) and exercise protocol. The association of various clinical and functional parameters was assessed statistically by using paired and unpaired t test, chi square test and McNemar's test. p < 0.05 indicated statistical significant.ResultsMean age of the patients in Group 1 was 57.6 ± 11.2 and in Group 2 54.5 ± 10.6 years. Before treatment, there were no significant differences between groups with respect to age, body mass index, spinal axial diameter, Visual Analogue Scale (VAS), spinal mobility, functional status and walking distance (p > 0.05). After 8 weeks of treatment, both groups benefited significantly with respect to VAS, functional status and walking distance (p < 0.001). There was no statistically significant difference between groups (p > 0.05).ConclusionIn 45 patients with lumbar spinal stenosis who received 8 weeks of treatment, concomitant use of calcitonin with physical therapy and exercise did not have any benefical effect on the patient's pain, functional status, lumbar mobility and walking distance.