Lumbar Region Research Articles

Tandem stenosis of the cervical and thoracic spine: a systematic review

BackgroundTandem spinal stenosis (TSS) is a condition characterized by the narrowing of the spinal canal in multiple segments of the spine. Predominantly observed in the cervical and lumbar regions, TSS also manifests in the conjunction of the cervical and thoracic spine. The simultaneous occurrence of cervical and thoracic spinal stenosis engenders intricate symptoms, potentially leading to missed and delayed diagnosis. Furthermore, the presence of tandem cervical and thoracic stenosis (TCTS) introduces a notable impact on the decision-making calculus of surgeons when contemplating either one-staged or two-staged surgery. Currently, there is no agreed-upon strategy for surgical intervention of TCTS in the literature.MethodsMedical databases in English (Pubmed, Web of Science, Embase, the Cochrane Database of Systematic Reviews) and Chinese (CNKI, Wanfang Data, VIP CMJD) were searched using Medical Subject Heading queries for the terms “tandem cervical and thoracic stenosis”, “cervical stenosis AND thoracic stenosis”, “tandem spinal stenosis” and “concomitant spinal stenosis” from January 1980 to March 2023. We included studies involving adult individuals with TCTS. Articles exclusively focused on disorders within a single spine region or devoid of any mention of spinal disorders were excluded.ResultsInitially, a total of 1625 literatures underwent consideration for inclusion in the study. Following the elimination of the duplicates through the utilization of EndNote, and a meticulous screening process involving scrutiny of abstracts and full-texts, 23 clinical studies met the predefined inclusion criteria. Of these, 2 studies solely focused on missed diagnosis, 19 studies exclusively discussed surgical strategy for TCTS, and 2 articles evaluated both surgical strategy and missed diagnosis.ConclusionOur study revealed a missed diagnosis rate of 7.2% in TCTS, with the thoracic stenosis emerging as the predominant area susceptible to oversight. Therefore, the meticulous identification of TCTS assumes paramount significance as the inaugural step in its effective management. While both one-staged and two-staged surgeries have exhibited efficacy in addressing TCTS, the selection of the optimal surgical plan should be contingent upon the individualized circumstances of the patients.

Primary premature ejaculation of kidney deficiency and liver stagnation treated with warm acupuncture of large-quantity moxibustion: a randomized controlled trial

To explore the clinical effect of warm acupuncture with large-quantity moxibustion on primary premature ejaculation (kidney deficiency and liver stagnation). A total of 240 patients with primary premature ejaculation (kidney deficiency and liver stagnation) were randomly divided into a warm acupuncture group (80 cases, 5 cases dropped out), an acupuncture group (80 cases, 4 cases dropped out) and a western medication group (80 cases, 6 cases dropped out). In the warm acupuncture group, a large quantity of moxibustion was delivered after acupuncture at Baihui (GV 20), Qihai (CV 6), Guanyuan (CV 4) and Zhongji (CV 3), as well as bilateral Fengchi (GB 20), lateral line 3 of forehead (MS 4), neishengzhiqi (TF2), Ganshu (BL 18), Shenshu (BL 23), and etc. One treatment with warm acupuncture took 40 min, once daily; five treatments were given per week and 4 weeks of treatment was required. In the acupuncture group, moxibustion was not delivered, and the rest operation of acupuncture was same as the warm acupuncture group. In the western medication group, dapoxetine hydrochloride tablets were administered orally, 30 mg each time, taken with warm water 1 h to 3 h before sexual intercourse. Medication was administered at most once within 24 h, twice per week, and 6 times within 4 weeks. Before and after treatment, the score of TCM symptoms, the score of premature ejaculation diagnostic tool (PEDT), intravaginal ejaculation latency time (IELT) and the serum sex hormone content (testosterone [T], luteinizing hormone [LH] and follicule stimulating hormone [FSH]) were observed and the clinical effect was evaluated in the three groups. After treatment, the scores for less duration of intercourse (<1 min), post-ejaculation fatigue, low spirit and decreased libido, and the total scores of TCM symptoms, as well as PEDT scores were reduced when compared with those before treatment in each group (P<0.01, P<0.05), and IELT was prolonged (P<0.01) in the three groups. The serum T content was increased when compared with that before treatment in the warm acupuncture group (P<0.05). After treatment, in comparison with the acupuncture group and the western medication group, the scores for post-ejaculation fatigue, soreness and weakness in the lumbar region and knee joints, decreased libido, insomnia, dream-disturbed sleep and frequent nocturnal enuresis, as well as the total score of TCM symptoms were lower (P<0.05, P<0.01) and the serum T content was increased (P<0.05) in the warm acupuncture group. When compared with the acupuncture group, PEDT scores were lower and IELT prolonged in the warm acupuncture group and the western medication group (P<0.05, P<0.01). The total effective rate was 82.7% (62/75) in the warm acupuncture group, higher than that of the acupuncture group (68.4%, 52/76) and the western medication group (64.9%, 48/74, P<0.05) respectively. Warm acupuncture with large-quantity moxibustion ameliorates the clinical symptoms and increases intravaginal ejaculation latency time and the levels of sex hormone in the patients with primary premature ejaculation (kidney deficiency and liver stagnation).

Is hamstring muscle shortness responsible for low back pain in healthcare professionals?

Background/Aim: Low back pain (LBP) is a highly prevalent pathology affecting more than half of our population. The lumbar region inherently possesses a complex structure; therefore, dozens of causes for the clinical presentation of acute/chronic pain are present. We focused on the impact of hamstring shortness on LBP in healthcare workers/professionals who need to keep medical records and perform invasive procedures while traveling overwhelming distances in relatively small workplaces. Methods: Our research was designed as a cross-sectional study and was conducted at Beykent University Hospital from March to April 2022. Sixty-two otherwise healthy healthcare workers/professionals aged 25–45 (both male and female) volunteered. Two equal groups with and without LBP were created. Oswestry disability index, Roland–Morris score, Quebec LBP questionnaire, Visual Analog Scale (VAS), active/passive knee extension, sit and reach, and forward bending tests were performed in each group. The collected data were statistically analyzed (confidence interval [CI]=20%; P&lt;0.05). Results: Active/passive knee extension, sit and reach, and toe touch tests were significantly related to Roland–Morris, Quebec, and Oswestry Disability Index questionnaires; thus hamstring muscle shortness was significantly related to chronic low back pain (P&lt;0.05). Short hamstring muscle length could accurately reflect the lower test scores obtained by the female participants. Conclusion: Hamstring muscle shortness could explain a significant proportion of low back pain in healthcare professionals.

Differences in spinal axial rotation angles during the lumbar-locked rotation test between hyper and normal thoracic rotation groups: A cross-sectional study.

Trunk rotation is important in many sporting activities The thoracic spine has reciprocal relationships with the lumbar and pelvic spines, such that reduced flexibility in the lumbar or thoracic spine can lead to abnormal patterns of trunk movement and pain. However, few studies have investigated the relative trunk rotation mobilities of the thorax, lumbar, and pelvis. To compare thoracic, lumbar, and pelvic rotation angles during the lumbar-locked rotation test between hyper and normal thoracic rotation groups. Thirty-two young, active participants were enrolled in this study. After the attachment of inertial measurement units at the T1, T7, T12, L3, and S2 levels, the participants were required to stand in a comfortable upright posture for 5s to allow postural measurements before performing the lumbar-locked rotation test. The participants were then divided into hyper thoracic rotation and normal thoracic rotation groups based on T1 angle measurements obtained during the lumbar-locked rotation test. The hyper thoracic rotation group had significantly higher thoracic rotation angles on both the right (p< 0.05) and left (p< 0.05) sides compared with the normal thoracic rotation group. Furthermore, we observed flat lumbar lordosis in the hyper thoracic rotation group compared with the normal thoracic rotation group, particularly in the lower lumbar region in standing posture. Our data suggest that evaluations of thoracic mobility should consider relative thoracic, lumbar, and pelvic motions, rather than the T1 angle alone. This study provides a basis for health professionals to evaluate movement dysfunctions associated with thoracic hypermobility.

Determining the effect of environmental factors, work postures and mental workload on musculoskeletal disorders in rescue workers and accidents of one of the water and sewage companies in Iran.

Musculoskeletal disorders are one of the most important problems faced by ergonomists today. This study was conducted with the aim of investigating the effect of weather conditions, working conditions and mental workload on musculoskeletal disorders of rescuers and water and sewage company accidents in hot and cold seasons. The present study was a longitudinal study that was performed on all employees of rescue and disaster teams of Shiraz Water and Sewerage Company in Iran (184 people) by census. Demographic and Nordic questionnaires, NASA Load Index (NASA-TLX), work environment assessment with temperature screening checklist and workplace ergonomic risk factor (WERA) assessment method were performed by the researcher. The collected data were analyzed using SPSS version 23 software and parametric and non-parametric statistical tests. The results showed that the highest and lowest prevalence of musculoskeletal disorders related to knee and back in winter and thigh in summer with prevalence of 57.1, 55.4 and 6%. The comparison of exposure to heat stress factors in summer and winter seasons showed that the temperature factors and work clothes of the workers in both seasons are in worse conditions than other factors (P < 0968). The results of the mental workload of people in two seasons showed that the highest and lowest mental workload is related to physical changes in the winter season and frustration in the summer season, and this relationship was significant (P < 0.001). Using multiple logistic regression model, the potential risk factors for musculoskeletal injuries including age, height, BMI, level of education and work experience in both hot and cold seasons were compared. The results showed that in summer, work experience (OR = 1.16 (1.06-1.28.)) and height (OR = 1.03(0.98-1.08) had a direct effect on the prevalence of pain and discomfort arranged in the back areas. One year of increase in work experience significantly increases the chance of a disorder in the back by 16% and a one centimeter increase in height increases the chance of a disorder in the lumbar region by 3%, although this relationship is significant. It is recommended that suitable solutions such as using appropriate and up-to-date mechanical tools, reducing activity time, increasing rest time, increasing the number of personnel in order to reduce mental workload, using work clothes suitable for the season and type of work, and ergonomics training for workers are on the agenda of company officials. Water and sewage should be placed.

Herpes Zoster Awareness: A pilot centre analysis

Herpes zoster (HZ), or shingles, is caused by the reactivation of the varicella-zoster virus (VZV), which typically occurs years after a primary VZV infection (chickenpox). HZ is characterized by a painful, unilateral vesicular rash that usually affects a single dermatome, with common sites including thoracic, lumbar, cervical, and trigeminal regions. While HZ typically lasts 2-4 weeks, it can be particularly severe in elderly and immunocompromised individuals, leading to complications such as postherpetic neuralgia (PHN), cranial nerve palsy, and visual deficits. The incidence of HZ increases with age, and early antiviral treatment with acyclovir can reduce the severity of the acute phase and prevent serious eye complications in ophthalmic HZ cases. With an aging population, the prevalence of HZ is expected to rise, highlighting the need for effective vaccination strategies. Two types of vaccines are available: a live attenuated zoster vaccine (LZV) and a recombinant zoster vaccine (RZV), with the latter showing higher efficacy in preventing HZ. Despite this, awareness of HZ and its vaccine remains low. A survey conducted in Izmir, Turkey, revealed that while 59.2% of respondents were aware of HZ, only 18.3% knew about the vaccine. The study underscores the need for increased public health efforts to raise awareness and promote vaccination, especially among high-risk populations such as the elderly and immunocompromised individuals.

Variations of the extrapsoas course of the lumbar plexus with implications for the lateral transpsoas approach to the lumbar spine: a cadaveric study

BackgroundTogether with an increased interest in minimally invasive lateral transpsoas approach to the lumbar spine goes a demand for detailed anatomical descriptions of the lumbar plexus. Although definitions of safe zones and essential descriptions of topographical anatomy have been presented in several studies, the existing literature expects standard appearance of the neural structures. Therefore, the aim of this study was to investigate the variability of the extrapsoas portion of the lumbar plexus in regard to the lateral transpsoas approach.MethodsA total of 260 lumbar regions from embalmed cadavers were utilized in this study. The specimens were dissected as per protocol and all nerves from the lumbar plexus were morphologically evaluated.ResultsThe most common variation of the iliohypogastric and ilioinguinal nerves was fusion of these two nerves (9.6%). Nearly in the half of the cases (48.1%) the genitofemoral nerve left the psoas major muscle already divided into the femoral and genital branches. The lateral femoral cutaneous nerve was the least variable one as it resembled its normal morphology in 95.0% of cases. Regarding the variant origins of the femoral nerve, there was a low formation outside the psoas major muscle in 3.8% of cases. The obturator nerve was not variable at its emergence point but frequently branched (40.4%) before entering the obturator canal. In addition to the proper femoral and obturator nerves, accessory nerves were present in 12.3% and 9.2% of cases, respectively.ConclusionNerves of the lumbar plexus frequently show atypical anatomy outside the psoas major muscle. The presented study provides a compendious information source of the possibly encountered neural variations during retroperitoneal access to different segments of the lumbar spine.

Epidemiological features of spinal intradural tumors, a single-center clinical study in Beijing, China

BackgroundSpinal intradural tumors are rare and heterogeneous in histological type, aggressiveness, and symptomatology, and there is a lack of data about them. This study investigated the epidemiological features of spinal intradural tumors.MethodsThis retrospective analysis included patients with spinal intradural tumors who underwent surgical treatment at the Myelopathy and Spondylosis Ward Beijing Jishuitan Hospital between January 2012 and December 2022.ResultsThis study included 1321 patients [aged 47.19 ± 14.90 years, 603 (45.65%) males] with spinal intradural tumors. The most common histological subtype was schwannoma [n = 511 (38.68%)], followed by spinal meningioma [n = 184 (13.93%)] and ependymoma [n = 101 (7.65%)]. Fifteen (1.14%) patients were diagnosed with metastatic spinal intradural tumors as a presentation of another primary cancer type. The spinal intradural tumors were mostly found in the lumbar region [n = 436 (33.01%)], followed by the thoracic vertebrae [n = 390 (29.52%)], cervical vertebrae [n = 154 (11.66%)], and thoracolumbar region [n = 111 (8.40%)]. Schwannomas mostly affected the lumbar region [n = 256 (52.64%)], spinal meningiomas in the thoracic region [n = 153 (83.15)], and ependymomas in the lumbar region [56 (55.45%)]. The de novo metastases were mostly found in the lumbar region [n = 8 (53.33%)].ConclusionAccording to the results of our single-center study, the most common spinal intradural tumor in Northern China is schwannoma, followed by spinal meningioma and ependymoma.

Malignant Hip Flexion Failure Syndrome: An Oncologic Disease Compared to Malignant Psoas Syndrome.

Malignant psoas syndrome (MPS) causes painful hip immobilization when a malignant tumor reaches the psoas muscle. However, there exists a different condition in which a malignant tumor invades the psoas muscle, leading to hip flexion failure without painful hip immobilization. This study aimed to define malignant hip flexion failure syndrome (MHFFS) as tumors located in the upper lumbar region or at the lesser trochanter of the femur, near the origin or termination of the psoas muscle, and to compare its prevalence, characteristics, and outcomes with those of classical MPS. We analyzed 291 patients who received palliative radiotherapy (RT) in the lumbar, pelvic, and lower leg regions from 2013 to 2023. The prevalence of MPS and MHFFS, pathological features, distinctive clinical presentations, treatment modalities, and treatment outcomes have been summarized. We also defined the 'Clinical sign reported by Ishikawa and Teramura (IT sign)' to describe the characteristic action of lifting the affected lower leg with both hands in MHFFS cases and assessed its clinical significance. Among the 291 patients, 6 (2.1%) had MHFFS and 11 (3.8%) had MPS. MHFFS resulted from metastatic tumors in the 11th and 12th thoracic vertebrae, as well as the 1st and 2nd lumbar vertebrae or the lesser trochanter of the femur, and it was characterized by hip and groin pain along with hip flexion dysfunction. All cases showed a positive IT sign. The response to RT varied, with symptomatic improvement observed in 50% of the patients. MPS is characterized by tumor invasion of the psoas muscle, causing severe lumbosacral nerve pain. Strong opioids were used for pain management in all patients, and epidural anesthesia was required in some patients. The median survival time of patients with MPS and MHFFS was 13.2 months. MPS required opioids more potently than MHFFS, but MHFFS responded relatively well to early RT.

Uniportal Full-endoscopic Foraminotomy for Lumbar Foraminal Stenosis: Clinical Characteristics and Functional Outcomes.

Uniportal full-endoscopic foraminotomy offers a promising alternative to conventional surgical methods for individuals afflicted by lumbar foraminal stenosis. This study aims to evaluate the efficacy and clinical outcomes of uniportal full-endoscopic foraminotomy in patients diagnosed with lumbar foraminal stenosis. A comprehensive retrospective analysis was conducted on individuals who underwent full-endoscopic foraminotomy in our medical center, between January 2018 and December 2019. The investigation encompassed the demographic data of patients and key clinical metrics such as the visual analogue scale of leg (VAS-L) and back pain (VAS-B), Oswestry disability index (ODI) scores, the Short Form-36 Health Survey physical component summary (SF-36 PCS) and the mental component summary (SF-36 MCS), as well as modified MacNab grades, were systematically assessed and compared. Furthermore, radiological parameters: Coronal Cobb angle (CCA), Intervertebral angle changes (IAC), Disc height index (DHI), the foraminal cross-sectional area (FCSA) and the FCSA enlargement ratio were also compared. A variety of statistical analyses including Student t-test, chi-square tests, Fisher's exact tests, Pearson's and Spearman's correlation analyses, and Interclass Correlation Coefficients (ICCs) were employed. 64 patients, including 34 males and 30 females were enrolled. The mean follow-up period extended to 22.66 ± 7.05 months. Distribution by affected segments revealed 26.6% at L4-5, 67.1% at L5-S1 level, and 6.25% at both L4-L5 and L5-S1 levels. At the final follow-up, VAS-L decreased from 7.26 ± 1.19 to 1.37 ± 1.25, while VAS-B decreased from 6.95 ± 0.54 to 1.62 ± 1.13 (p < 0.001). ODI score also demonstrated a substantial decrease from 74.73 ± 8.68 to 23.27 ± 8.71 (p < 0.001). Both SF-36 PCS and SF-36 MCS scores improved significantly (p < 0.001). Modified MacNab criteria revealed 58 excellent-good patients (90.7%), and 6 fair-poor patients (9.3%). No significant differences were founded in the CCA (p = 0.1065), IAC (p = 0.5544), and DHI (p = 0.1348) between pre-operation and the final follow-up. However, the FCSA significantly increased from 73.41 ± 11.75 to 173.40 ± 18.62 mm2 (p < 0.001), and the enlargement ratio was 142.9% ± 49.58%. Notably, the final follow-up FCSA and the FCSA enlargement ratio were found to be larger in the excellent and good group compared to the fair and poor group, according to the modified MacNab criteria. The utilization of uniportal full-endoscopic foraminotomy has demonstrated its safety and efficacy in addressing lumbar foraminal stenosis. The clinical success of this procedure appears to be closely associated with the radiological decompression of the intervertebral foramen area. Importantly, the application of this technology does not seem to compromise the overall stability of the lumbar region.

Clinical Outcome of Posterior Instrumented Stabilization and Transpedicular Decompression in Patients Presenting with Thoracic or Lumbar Spinal Tuberculosis in a Tertiary Care Center: A Descriptive Cross-sectional Study.

Posterior instrumented stabilization is a commonly done surgery in spinal tuberculosis. This study aims to evaluate the clinical, radiological, and neurological outcomes of posterior instrumented stabilization and transpedicular decompression in thoracic and lumbar spinal tuberculosis. A descriptive cross-sectional study was conducted for one and a half years with at least six months of follow-up in a tertiary care center. The study was approved by the Institutional Review Committee (Reference number: 119 (6-11-5) 2/075-076). Total sampling was done and the study included patients over 18 years of age with spinal tuberculosis of the thoracic or lumbar regions. These patients underwent posterior instrumented stabilization and transpedicular decompression at the tertiary care center. The age, site of involvement, Visual Analog Scale score for back pain, neurological status as per Frankel Neurology grading, and local kyphotic angle in X-ray were recorded. The median, interquartile range and percentage were calculated. The data was entered in Microsoft Excel 2016 and analysis was done using Epi Info software version 7.2. Thoracic level was most commonly involved in 14 (46.68%) cases. The median back pain as assessed by the Visual Analogue Scale score improved from 8 to 2 at the 6-month follow-up. There was improvement in the neurological grading of all cases and there was no loss of correction in the local kyphotic angle till the final follow-up. The median age of cases was 48 years (interquartile range: 28-62.50). Posterior instrumented stabilization and transpedicular decompression in adult patients with thoracic or lumbar spinal tuberculosis achieves improvements in clinical, radiological, and neurological outcomes.

The effect of transcutaneous electrical nerve stimulation on lumbar range of motion and lumbar fascia characteristics in healthy individuals

ObjectivesTo investigate the effect of Transcutaneous electrical nerve stimulation (TENS) on lumbar fascia thickness, lumbar flexion angle, and lumbar curvature in healthy people. DesignRandomized, clinical trial. Subjects100 healthy individuals. InterventionsParticipants were randomized into the active TENS group (n = 50) and placebo TENS group (n = 50). Subjects received 10 sessions of TENS in the lumbar region for 2 weeks. Main measuresLumbar fascia thickness, lumbar flexion angle, and lumbar curvature examined by ultrasonography, flexible ruler, and spinal mouse three times (before and after the intervention sessions, and two weeks after the last intervention session-follow up) ResultsSubjects in the TENS group showed a significant reduction in lumbar fascia thickness (P ≤ 0.002), an increase in lumbar flexion angle (P = 0.000), and an increase in lumbar curvature angle (P = 0.000) before and after the intervention sessions. The results of the follow-up evaluations showed the stability of the changes in the mentioned variables. ConclusionThe improvements in the lumbar fascia thickness and lumbar flexibility suggest that TENS may be effective in healthy subjects. Data indicate that biomechanical properties of lumbar fascia and lumbar flexibility are directly linked, and other mechanisms could be more influential in contributing to improvement.

Imaging characteristics and surgical effect for symmetrical lumbar hemivertebrae

Objective: To analyze the imaging characteristics and surgical effect for symmetrical lumbar hemivertebrae in pediatric patients. Methods: The data of 13 patients with hemivertebrae locating in the lumbar spine symmetrically were retrospectively analyzed, and all the patients were treated in Beijing Children's Hospital from January 2015 to September 2021. The mean age of the patients was 6.2 (2.9, 9.3) years. There were 8 males and 5 females. The data of coronal/sagittal plane including segmental Cobb angle, cranial/caudal compensatory curve, thoracic kyphosis, thoracolumbar kyphosis, sacral obliquity, and lumbar lordosis were recorded through long cassette spinal radiographs. Associated anomalies and the relationship between hemivertebrae and posterior component were recorded through computerized tomography (CT) and magnetic resonance imaging (MRI). All the patients received surgery, and their pre-and postoperative imaging data were compared. Results: A total of 26 hemivertebraes were found, in which 80.8% (21/26) located below L2. Hemivertebraes in 10 patients were separated by a mean 1-2 normal vertebrae. Most hemivertebraes along with the corresponding posterior component were unison (21/26, 80.8%). The Cobb angles of cranial compensatory curve (13.9°±7.2°) was more serious than that of caudal compensatory curve (5.5°±5.0°)(P=0.04). The lumbar lordosis and thoracic kyphosis was 20.2°±15.0° and 18.7°±9.2°, respectively. Six patients complicated with sacral obliquity, while 7 patients complicated with thoracolumbar lordosis. Associated anomalies were found in 6 (46.2%) patients through CT and MRI. Eleven patients received one-or two-stage posterior hemivertebrae resection with short segmental fusion, and 2 patients received one-stage hemivertebrae resection with long segmental fusion. All the surgery were completed successfully without serious complications such as nerve injury, infection, and implant failure. The mean follow-up period was (42.4±10.2) months. At the last follow-up point, the correction rate of segmental Cobb angle and cranial compensatory curve was 83.3%±15.6% and 38.1%±10.4%, respectively, showing significant improvement (P<0.05). Although the caudal compensatory curve, sacral obliquity, and thoracic kyphosis improved after surgery, the data showed no significant difference compared to that before surgery. Thoracolumbar lordosis in all patients were corrected. Conclusions: Most hemivertebraes in such spinal deformity locate in lower lumbar region with a high incidence of anomalies. Individualized treatment based on patients' condition is essential for the complicated spinal deformity.

Coexistence of neural tube defects and spinal arteriovenous shunts: a case series and review of literature.

Spinal arteriovenous shunts and spinal dysraphism both have a different underlying cause, disease spectrum and developmental process; hence, these entities rarely coexist in a patient. Here, we reported four cases of coexistence of adult-onset spinal arteriovenous shunt and spinal dysraphism in the same patient along with their therapeutic embolisation. Additionally, we conducted an extensive literature review to explore the potential theories and explanations for this coexistence. We retrospectively searched our imaging database from January 2015 to December 2023 to identify instances of spinal arteriovenous shunts occurring in patients with spinal dysraphism or neural tube defect disorders. MRI and angiographic imaging, clinical presentation, treatment and follow-up were analysed. Four patients with arteriovenous fistula/shunt and spinal dysraphism were included in the study. The mean age of presentation was 35.5years. The most common symptoms were sensory disturbance and motor weakness. Arteriovenous fistula or shunt was located at the lumber region in one patient and at the sacral region in three cases. Two patients have a prior history of surgery in first decade. Two patients were treated with glue embolisation. The internal iliac artery was a common feeder in all cases. The rare coexistence of neural tube defects with spinal vascular abnormalities should be considered when assessing a middle-aged patient with neural tube defect and myelopathy. Correct diagnosis can help in treatment planning and thereby improve prognosis.

Swimming Velocity Analysis Using Wearable Inertial Sensors and Speedometer: A Comparative Study.

The speedometer is widely used to evaluate swimming velocity but has some constraints. With the constant development of inertial units (IMUs), it is expected that they will become a good alternative to the speedometer. This study aimed to compare the data retrieved by an IMU and a speedometer when breaststroke is performed at maximum speed. Sixteen swimmers, nine males and seven females (20.3 ± 3.3 vs. 18.7 ± 1.1 years old, 65.8 ± 11.2 vs. 57.7 ± 9.1 kg of body mass and 1.75 ± 0.07 vs. 1.61 ± 0.10 m of height, respectively), performed 4 × 25 m of breaststroke sprint. They were equipped with an IMU fixed to the sacrum and with the line of an electromechanical speedometer (acquisition frequency of 50 Hz) fixed at the central point in the lumbar region. Statistical parametric mapping was used to compare the velocity curves, IBM SPSS was used for descriptive statistics and Bland-Altman plots were used for agreement of measurements. The results show that the IMU and speedometer do not show similar patterns, and the velocity values measured by the IMU are lower (p < 0.001). Bland-Altman plots presented a larger bias in terms of coefficient of variation and intracycle velocity variation. It can be concluded that IMUs and speedometers are not substitutes for each other as methods for evaluating intracycle velocity variations.

Evaluating the effect of injection protocols on intrathecal solute dispersion in non-human primates: an in vitro study using a cynomolgus cerebrospinal fluid system

BackgroundAchieving effective drug delivery to the central nervous system (CNS) remains a challenge for treating neurological disorders. Intrathecal (IT) delivery, which involves direct injection into the cerebrospinal fluid (CSF), presents a promising strategy. Large animal studies are important to assess the safety and efficacy of most drugs and treatments and translate the data to humans. An understanding of the influence of IT injection parameters on solute distribution within the CNS is essential to optimize preclinical research, which would potentially help design human clinical studies.MethodsA three-dimensional (3D) in vitro model of a cynomolgus monkey, based on MRI data, was developed to evaluate the impact of lumbar injection parameters on intrathecal solute dispersion. The parameters evaluated were (a) injection location, (b) bolus volume, (c) flush volume, (d) bolus rate, and (e) flush rate. To simulate the CSF flow within the subarachnoid space (SAS), an idealized CSF flow waveform with both cardiac and respiratory-induced components was input into the model. A solution of fluorescein drug surrogate tracer was administered in the lumbar region of the 3D in vitro model filled with deionized water. After injection of the tracer, the CSF system wide-solute dispersion was imaged using high-resolution cameras every thirty seconds for a duration of three hours. To ensure repeatability each injection protocol was repeated three times. For each protocol, the average spatial–temporal distribution over three hours post-injection, the area under the curve (AUC), and the percent injected dose (%ID) to extra-axial CSF (eaCSF) at three hours were determined.ResultsThe changes to the lumbar injection parameters led to variations in solute distribution along the neuro-axis. Specifically, injection location showed the most impact, enhancing the delivery to the eaCSF up to + 10.5%ID (p = 0.0282) at three hours post-injection. Adding a post-injection flush of 1.5 ml at 1 ml/min increased the solute delivery to the eaCSF by + 6.5%ID (p = 0.0218), while the larger bolus volume resulted in a + 2.3%ID (p = 0.1910) increase. The bolus and flush rates analyzed had minimal, statistically non-significant effects.ConclusionThese results predict the effects of lumbar injection parameters on solute distribution in the intrathecal space in NHPs. Specifically, the choice of injection location, flush, and bolus volume significantly improved solute delivery to eaCSF. The in vitro NHP CSF model and results offer a system to help predict and optimize IT delivery protocols for pre-clinical NHP studies.

Low Back Pain Risk Among Athlete: A Scientometric Study

Low back pain (LBP) emerges as a prevalent concern within the athletic community, characterized by a noteworthy proclivity for recurrence. The repeated occurrence of LBP substantially impedes athletes and adversely affects their performance. As such, it becomes imperative to discern the underlying factors contributing to injuries in the lumbar region. The scientometric analysis will provide a clear pathway for researchers to understand the current state and evolution of the theme research area of low back pain risk among athletes. No scientometric study on this theme has been undertaken until today. Therefore, this research objective was to collect data from the database to identify the present trend of low back pain risk, development patterns, and current research. Software that has been utilized for commonness, co-occurrence, clustering, co-citation and analysis of burst was CiteSpace. A scientometric review of studies on athletes' low back pain risk from 2000 to 2023 finds considerable additional studies in the amount of literature, the citation frequency, and the hotspots available. The most influential author is Douglas W. Jackson, the most influential article is Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Thoraco-lumbar spine is the most common cluster, whereas the most popular keyword is spondylolisthesis. In conclusion, low back pain is becoming one of the future study topics. Furthermore, many stakeholders must be aware of current trends and advances in the athlete's low back pain risk.

Gait Analysis with Wearable Sensors in Isolated REM Sleep Behavior Disorder Associated with Phenoconversion: An Explorative Study.

Gait disturbance is a vital characteristic of motor manifestation in α- synucleinopathies, especially Parkinson's disease. Subtle gait alterations are present in isolated rapid eye movement sleep behavior disorder (iRBD) patients before phenoconversion; it is yet unclear, if gait analysis may predict phenoconversion. To investigate subtle gait alterations and explore whether gait analysis using wearable sensors is associated with phenoconversion of iRBD to α-synucleinopathies. Thirty-one polysomnography-confirmed iRBD patients and 33 healthy controls (HCs) were enrolled at baseline. All participants walked for a minute while wearing 6 inertial sensors on bilateral wrists, ankles, and the trunk (sternal and lumbar region). Three conditions were tested: (i) normal walking, (ii) fast walking, and (iii) dual-task walking. Decreased arm range of motion and increased gait variation (stride length, stride time and stride velocity) discriminate converters from HCs at baseline. After an average of 5.40 years of follow-up, 10 patients converted to neurodegenerative diseases (converters). Cox regression analysis showed higher value of stride length asymmetry under normal walking condition to be associated with an early conversion of iRBD to α- synucleinopathies (adjusted HR 4.468, 95% CI 1.088- 18.349, p = 0.038). Stride length asymmetry is associated with progression to α- synucleinopathies in patients with iRBD. Gait analysis with wearable sensors may be useful for screening, monitoring, and risk stratification for disease-modifying therapy trials in patients with iRBD.

EMPLOYMENT OUTCOMES FOLLOWING THORACOLUMBAR FRACTURES: LONG-TERM FOLLOW-UP GREATER THAN FIVE YEARS

Study designRetrospective study.ObjectivesTo identify patient outcomes, in particular employment, &gt;5-years following traumatic thoracolumbar fracture.Methods235 patients between the ages of 18–65 were identified from the hospital radiology database having sustained a traumatic thoracolumbar fracture on CT or MRI between 01/01/2013 and 31/01/2017. Questionnaires were sent out via post and available emails, with a reminder letter and phone calls. Retrospective data was gathered about employment status pre-fracture and &gt;5-years post injury.Results26 patients had died at follow up leaving 209 patients. 108 (52%) were treated surgically and 101 (48%) conservatively. 106 replies were received with 85 (80%) opting in and 21 (20%) opting out. 68 (80%) patients completed the full questionnaire with 17 (20%) filling out a shortened questionnaire via a phone conversation. 52 (61%) patients underwent surgery and 33 (39%) were treated conservatively. The average follow up was 8 years. Prior to injury 66 (78%) were employed and 19 (22%) unemployed (of which 6 were full time students and 8 were retired). 49 (74%) of the previously employed patients returned to work at follow up with 35 (53%) working the same or increased hours. Regarding employment, there was no significant difference between surgically and conservatively treated patients (P=0.355) or the classification of the fracture (P=0.303). 16 (19%) patients reported back pain prior to their injury whilst 69 (81%) did not. There were 58 (68%) cases of new pain at follow up with the most affected area being the lumbar region in 43 (51%) patients. 32 (38%) patients reported neurological deficit post injury: 19 with subjective symptoms, 9 with objective symptoms and 4 suffered paralysis.Conclusion&gt;5-years following a traumatic thoracolumbar fracture most individuals return to employment. There was no significant difference between the severity of the fracture or how patients are treated on their employment outcomes.

Does Routine Post-Operative Use of Drainage in Minimally Invasive Lumbar Spine Surgery Offer Better Results?

Objective: The advantages of minimally invasive spine surgery (MISS) in lumbar degenerative diseases have been well described (less tissue damage, shorter hospital stay, better results in pain assessment). One aspect that has not yet been studied enough is the usage of a post-operative drain in MISS. The aim of this study was to determine whether drainage in MISS is necessary or not and what advantages or disadvantages its use offers. Materials - Methods: We conducted a systematic review of the published literature, searching articles published on Pubmed and Embasse until December 1st 2022, regarding MISS in the lumbar region and post-operative drain usage. Our inclusion criteria were original articles written in English and articles using minimally invasive techniques (usage of tubular retractors along with an endoscope or microscope, paramedian incision, percutaneous screw placement). 42 articles were assessed, and after careful examination and duplication exclusion, 26 research papers were included. Usage, type and duration of postoperative drainage, length of hospital stay, ambulation time and complications were extracted, and relevant results were pooled. Results: The majority of the included articles (80.7 %) reported using a negative-pressure post-operative drain tube. Drains were removed either 48 hours after surgery or when the drainage volume was less than 50ml/24h. Hospital stays and time to ambulation were shorter in cases where drainage was not used. There was no difference in complications between cases where drainage was used and those that it was not. Conclusion: The rationale behind post-operative drainage in MISS is to protect from surgical site infections and hematoma creation. Based on our study there is no evidence to support this hypothesis. On the contrary, our results suggest that the drawbacks of using a drain (pain, discomfort, anxiety, inconvenience of mobilisation, prolongation of hospitalisation) outweigh the advantages, thus making the routine use of postoperative drainage in MISS unnecessary.