Lumbar Spine In Patients Research Articles

Peculiarities of Preoperative Planning of Total Hip Arthroplasty in Patients with Hip-Lumbar Syndrome

Summary. At present, no scheme of approach to surgical treatment of patients with hip-lumbar syndrome (HLS) depending on the type of vertical posture and the type of bone formation and progression of coxarthrosis is developed. The decision of these questions, interesting from the scientific and practical point of view, is an actual task of modern orthopedics and defines features of preoperative planning of total hip arthroplasty (THA) in patients with HLS.
 Objective: to determine the features of preoperative planning of total hip arthroplasty in patients with hip-lumbar syndrome.
 Materials and Methods. The basis for the development of recommendations for preoperative planning of THA in patients with HLS was the data of retrospective analysis of medical histories of 138 patients who underwent hip arthroplasty in the Department of Orthopedics and Traumatology of Adults of SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine”. The data of the clinical study of 506 patients with idiopathic, dysplastic and post-traumatic coxarthrosis conducted earlier were also taken into account, and the tactics of treatment in cementless hip arthroplasty was developed.
 Results. It was determined that the vertical posture affects the progression of coxarthrosis and the nature of the lesion of the lumbar spine in patients with HLS. Patients with a certain hypolordotic posture and a rapid course of coxarthrosis are recommended to undergo primary decompression of the spinal roots and THA at the second stage. In other cases, the initial implementation of THA is recommended. Recommendations for the use of the type and method of fixation and coverage of the leg of the endoprosthesis depending on the type of bone formation in the HLS of the examined patients are developed.
 Conclusions. Taking into account the features of preoperative planning of THA in patients with HLS will reduce the number of negative results and complications of this category of orthopedic patients.

P91. How does gravity influence the distribution of lordosis in sagittal malalignment?

<h3>BACKGROUND CONTEXT</h3> Supine imaging reveals the contour of the spine without gravity, a key consideration in surgical planning. Comparing supine to standing radiographs may reveal differences in regional flexibility in adult spinal deformity (ASD). <h3>PURPOSE</h3> To determine differences in regional flexibility of the lumbar spine in patients with ASD. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> Fifty-six patients with sagittal ASD (SRS-Schwab Type N, no previous fusion) and 119 asymptomatic volunteers. <h3>OUTCOME MEASURES</h3> PI-LL, L1-L4, and L4-S1 alignment. <h3>METHODS</h3> Asymptomatic volunteers underwent full length standing radiographs, ASD patients had standing and supine radiographs taken for preoperative planning. The standing alignment of the asymptomatic volunteers (50.7±17 years, PI 52±11.4°) was analyzed using linear regression in order to calculate PI-based formulas for normative, age-adjusted standing PI-LL, L4-S1, and L1-L4. These formulas were applied to the ASD cohort and compared to their standing and supine alignment. Given the potential for confounding by ASD patients with stiff lumbar spines, analyses were repeated in a cohort of 25 patients with at least 5° of flexibility (defined as the difference between supine and standing lordosis) and 5 degrees of offset from regional alignment norms. <h3>RESULTS</h3> Linear regression in the asymptomatic cohort resulted in the following PI based formulas: PI-LL= -38.3 +0.41*PI +0.21*Age, L4-S1= 45.3 -0.18*Age, L1-L4= -3 + 0.48*PI). The ASD cohort had a mean age of 65±14 years, BMI 29±7 kg/m2, standing PI-LL 14±22°, T1PA 22±11°). Eighty-seven percent of patients had a lordotic apex between the L3-L4 inferior endplates. PI-LL improved with supine positioning (mean 8.9±18.7°, p<0.001), though not enough to correct to age-matched norms (mean offset 12.2±16.9°). Compared to mean normative alignment at L1-L4 (22.1±6.2°), L1-L4 was flatter on standing (7.2±17.0°, p<0.001) and supine imaging (8.5±15.0°, p<0.001) while L4-S1 was comparable (norm 33.6±2.6 vs standing 30.9±12.9, p=0.325; vs supine 34.5±10.3, p=1.000). Subgroup analysis of subjects with L1-S1 flexibility >5° demonstrated a more dramatic effect—the standing loss of lordosis (32.6±1.7° norm vs 25.5±12.7° standing, p=0.031) at L4-S1 corrected on supine imaging (33.9±11.1°, p=1.000), while L1-L4 alignment did not (23.0±6.2° norm vs 2.2±14.4° standing, p<0.001; vs 7.3±12.9° supine, p<0.001). <h3>CONCLUSIONS</h3> When the effect of gravity is removed, the distal portion of the lumbar spine (i.e., below the apex of lordosis) corrects, suggesting that deformity is contained in the proximal lumbar region. These findings illuminate the etiology of lumbar hypolordosis and may influence selection of fusion levels. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

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

PurposePelvic morphology dictates the alignment and biomechanics of the spine. Recent observations in different types of adolescent idiopathic scoliosis indicate that individual pelvic morphology is related to the spinal levels in which scoliosis develops: primary lumbar adolescent scoliosis is associated with a higher pelvic incidence (PI) than thoracic scoliosis and non-scoliotic controls. We hypothesize that adult degenerative scoliosis (ADS) of the lumbar spine follows the same mechanical principles and is associated with a high PI.MethodsThis study used an existing CT-scan database, 101 ADS patients were sex and age matched to 101 controls. The PI was measured by two observers with multi-planar reconstruction, perpendicular to the hip-axis according to a previously validated technique.ResultsThe PI was 54.1° ± 10.8° in ADS patients and 47.7° ± 10.8° in non-scoliotic controls (p < 0.001). The median ADS curve apex was the disc L2-3 and median curve length was 4 vertebral levels. The mean supine Cobb angle was 21° ± 8° (ranged 10°–47°). There was no significant correlation between PI and the apex level (p = 0.883), the curve length (p = 0.418) or the Cobb angle (p = 0.518).ConclusionsADS normally develops de novo in the lumbar spine of patients with a higher PI than controls, similar to primary lumbar adolescent idiopathic scoliosis. This suggests a shared mechanical basis of both deformities. Pelvic morphology dictates spinal sagittal alignment, which determines the segments of the spine that are prone to develop scoliosis.

The association between spondylolisthesis and decreased muscle health throughout the lumbar spine for patients with operative lumbar spinal stenosis.

There are data underlining the relationship between muscle health and spine related pathology, but little data regarding changes in paralumbar muscle associated with lumbar spondylolisthesis. We aimed to define changes in paralumbar muscle health associated with spondylolisthesis. A retrospective review was performed on consecutive patients with lumbar spine pathology requiring an operation. A pre-operative lumbar MRI was analysed for muscle health measurements including lumbar indentation value (LIV), paralumbar cross-sectional area divided by body mass index (PL-CSA/BMI), and Goutallier classification of fatty atrophy. All measurements were taken from an axial slice of a T2-weighted image at lumbar disc spaces. Baseline health-related quality of life scores (HRQOLs), narcotic use and areas of stenosis were tracked. We performed Chi-square analyses and student's t test to determine statistically significant differences between cohorts. There were 307 patients (average age 56.1 ± 16.7years, 141 females) included within our analysis. 112 patients had spondylolisthesis. There were no differences in baseline HRQOLs between the spondylolisthesis cohort (SC) and non-spondylolisthesis cohort (non-SC). There were significantly worse PL-CSA/BMI at L2-L3 (p = 0.03), L3-L4 (p = 0.04) and L4-L5 (p = 0.02) for the SC. Goutallier classification of paralumbar muscle was worse for SC at L1-L2 (p = 0.04) and at L4-L5 (p < 0.001). Increased grade of spondylolisthesis was associated with worse PL-CSA at L1-L2 (p = 0.02), L2-L3 (p = 0.03) and L3-L4 (p = 0.05). Similarly, there were worse Goutallier classification scores associated with higher-grade spondylolisthesis at all levels (p < 0.05). There are significant detrimental changes to paralumbar muscle health throughout the lumbar spine associated with spondylolisthesis.

Comparison of Bone Mineral Density at Hip and Lumbar Spine in Patients with Femoral Neck Fractures and Pertrochanteric Fractures.

Geriatric hip fractures, including femoral neck and pertrochanteric fractures, are common nowadays, which is related to increasing numbers of elderly people worldwide. Osteoporosis is an important risk factor associated with hip fractures. This study aimed to describe the association of hip fractures and osteoporosis at different BMD measurement sites and determine any differences between these two types of hip fracture. A retrospective study conducted in a university hospital in the south of Thailand enrolled 223 patients aged over 50 years with low-energy trauma hip fractures. Each patient had undergone dual energy x-ray absorptiometry (DXA) within 2 weeks of injury. T-scores were recorded for the total hip, femoral neck and lumbar spine areas and classified as normal, osteopenia and osteoporosis according to WHO osteoporosis diagnostic criteria. The highest proportion of T-scores in the osteoporotic range were registered at the femoral neck (68.6%) compared to total hip (52.9%) and lumbar spine (47.7%). At least 31.4% of patients were in the non-osteoporotic range. No significant differences were found at all sites of BMD measurement between the two types of fracture. 1. At least 1/3 of patients with geriatric hip fractures had their T-scores in the normal to oste-ope-nic range. 2. BMD in different areas is not different between types of hip fractures.

Transvertebral magnetic neuromodulation for the treatment of overactive bladder: 6 months follow-up

Introduction. The most common type of lower urinary tract dysfunction is an overactive bladder (OAB). Today there is a need to search for new effective methods of treating this disease.Purpose of the study. To evaluate the effectiveness of transvertebral magnetic neuromodulation (TMN) of the lumbar spine in patients with OAB.Materials and methods. 26 patients were enrolled in the clinical study. The treatment course consisted of 15 procedures (3 times a week for 5 weeks). Before and after treatment at 1, 3 and 6 months, complaints were assessed using the ICIQ-SF and OAB-q SF questionnaires. Objective parameters were assessed by urodynamic tests before and 6 months after treatment.Results. We observed a significant improvement in patients subjective clinical status at all points of assessment. Transvertebral magnetic neuromodulation had the greatest influence on such urodynamic parameters as the first sensation, the first desire, strong desire, maximum cystometric capacity. Patterns of phase hyperactivity were absent in 60.8% of patients after treatment and terminal hyperactivity in 41.7% of patients.Conclusions. This small study observed a significant therapeutic effect of TMN in patients with OAB. Further large placebo-controlled trials are needed to develop universal effective protocols for lower urinary tract dysfunction treatment.

No relationship between bone mineral density and syndesmophyte formation at the same level in the lumbar spine of patients with radiographic axial Spondyloarthritis

ObjectiveTo investigate if in radiographic axial Spondyloarthritis (r-axSpA) low vertebral bone mineral density (BMD) is associated with development of new syndesmophytes at the same vertebral level.MethodsIn a post-hoc analysis from...

Accuracy of Freehand versus Navigated Thoracolumbar Pedicle Screw Placement in Patients with Metastatic Tumors of the Spine.

ObjectiveTo compare the accuracy and breach rates of freehand (FH) versus navigated (NV) pedicle screws in the thoracic and lumbar spine in patients with metastatic spinal tumors. MethodsA retrospective review of adult patients who underwent pedicle screw fixation in the thoracic or lumbar spine for metastatic spinal tumors between 2012 and 2018 was conducted. Breaches were assessed based on the Gertzbein and Robbins classification and only screws placed >4 mm outside of the pedicle wall (lateral or medial) were considered breached. ResultsA total of 62 patients received 547 pedicle screws (average 8 per patient) – 34 patients received 298 pedicle screws in the FH group and 28 patients received 249 screws in the NV group. There were 40/547 breaches, corresponding to a breach and accuracy rate of 7.3% and 92.7%, respectively. The breach rate was 9.7% in the FH group and 4.4% in the NV group (chi-squared test, p=0.017); this corresponded to an accuracy rate of 90.3% and 95.6%, respectively. Only one patient from the overall cohort (in the FH group) required revision surgery due to a medial breach abutting the spinal cord (1.6% of all patients; 2.9% of FH patients); no patient suffered organ, vessel, or neurological injury from screw breaches. ConclusionNavigated pedicle screw placement in patients with metastatic spinal tumors has a significantly higher radiographic accuracy compared to the FH technique. However, the revision surgery was low and no patient suffered from clinically-relevant breach. Navigation also offers the advantage of real-time localization of spinal tumors and aids in targeting and resection of these lesions.

Role of deteriorated bone quality in the development of osteoporosis in pheochromocytoma and paraganglioma.

Pheochromocytoma (PHEO) and paraganglioma (PGL) (PHEO and PGL: PPGLs), catecholamine-producing tumors, represent an emerging cause of secondary osteoporosis. However, despite decreased bone mineral density (BMD), vertebral fracture (VF) is not associated with BMD in PPGLs. To evaluate whether deteriorated bone quality is involved in the development of osteoporosis in PPGLs. Trabecular bone score (TBS), used to assess trabecular bone quality, was examined in 56 patients with PPGLs and 52 with non-functional adrenal tumors (AT). Radiograph of the spine was carried out in 35 patients with PPGLs, and TBS was analyzed in 18 patients with PPGLs at follow-up. TBS and BMD at the lumbar spine in patients with PPGLs with and without VF. PPGLs had a lower TBS (n=56, 1.338 [1.294-1.420]) than non-functional AT (n=52, 1.394 [1.342-1.444]; p=0.033). Among those with PPGLs, patients with VF (n=14, 1.314 [1.289-1.346]) had a lower TBS than those without VF (n=21, 1.383 [1.324-1.426]; p=0.046), despite no significant difference in BMD at the lumbar spine between the two groups (p=0.501). An optimal cut-off level of TBS for diagnosing VF in PPGLs was 1.323, and its area under the curve was 0.702. The severity of catecholamine excess and maximal size of tumor were associated with decreased TBS in PPGLs patients (p=0.016 and p=0.020, respectively). Surgical resection of PPGLs improved TBS at follow-up, with 2.5% increase (p=0.007). This study provides evidence for the importance of deteriorated bone quality rather than decreased bone mass in the development of VF in PPGLs.

Performance of bone mineral density and trabecular bone score in assessment of bone quality in Egyptian male patients with ankylosing spondylitis

BackgroundOsteoporosis is a common complication of ankylosing spondylitis (AS) even in the early stages of disease; however, previously published studies have demonstrated large discrepancies in the reported incidence of osteoporosis, based on measurement of bone mineral density (BMD). The aim of the present study was to compare bone quality using trabecular bone score (TBS) between AS patients and healthy controls and to evaluate factors associated with TBS in patients with AS.ResultsAnkylosing spondylitis patients had significantly lower BMD and T score at the neck of femur and lower total hip BMD than controls (BMD p = 0.010 and 0.032 respectively), (T score p = 0.006 and p = 0.025 respectively). The mean TBS was significantly lower in AS patients than in controls (p < 0.001). Lumbar spine TBS was directly correlated with BMI (p = 0.029) and BMD at the neck of femur (p = 0.016) and BMD of total hip (p = 0.007) while inversely correlated with the Bath AS Metrology Index (BASMI) (p = 0.026), the modified Stoke AS Spinal Score (mSASS) (p = 0.029), ESR (p = 0.031), and CRP (p = 0.033).ConclusionTBS evaluation detected lower bone quality in the lumbar spine in patients with AS when compared with matched controls, while lumbar BMD failed to identify it. These findings encourage the use of TBS as a beneficial tool to recognize the risk of axial osteoporosis as early as possible in AS patients. Also, we recommend its use for regular follow up of drug treatment for those patients.

Determining the biomechanical changes in lumbar spine among patients with injuries around the knee joint: a systematic review protocol

The knee is one of the body's more complicated joints and is susceptible to various injuries. A closed kinetic relationship exists between the lumbar spine and knee joint and any dysfunction in knee or lumbar region may result in compensation, joint dysfunction and pain in either one or both the regions. Therefore, the above stated reason highlights the need of analyzing the spine biomechanically. So, that a new physiotherapeutic assessment and treatment approach can be developed in future to prevent permanent adaptive changes in the posture in patients with knee injuries. This systematic review protocol has been conducted by two independent reviewers who searched the articles using electronic search for publications in several databases: Google Scholar, Index Copernicus, JSTOR, PubMed/Medline, ScienceDirect, Scopus and Web of Science. After applying the selection criteria, study papers published between the years 2001 to 2019 have been selected. Studies of human participants of any age having injuries around knee joint have been eligible, and there was no restriction on type of injuries. All the study papers have been analyzed using modified Downs and Black scale and scores have been awarded for the items selected on a 27 point scale. This review has collected secondary data only; hence no ethical approval was required. The results of this review protocol will provide evidence regarding changes in lumbar spine in patients with injuries around knee and this information will be useful in planning for rehabilitation in knee and around knee injury.

Brown Tumor of Lumbar Spine in a Patient with Primary Hyperparathyroidism: Case Report

Background Data: Brown tumor is a lytic bone tumor and has variable symptoms according to the affected site. It is called brown because of its characteristic brown color believed to have occurred after accumulation of blood, fibrous tissue, and hemosiderin. Hyperparathyroidism can result in a brown tumor whether it is primary or secondary, but this case is much rarer in primary hyperparathyroidism. It rarely affects the spine, while it is extremely rare to compromise the spinal canal. Purpose: To report a rare case of lumbar spinal brown tumor with primary hyperparathyroidism. Study Design: A case report of brown tumor of the lumbar spine (5th lumbar vertebrae). Patients and Methods: Our case was a forty-year-old female patient presenting with persistent dull aching low back pain. There was no history of any chronic illness. She had a 5-month history of slowly progressive left lower limb radicular pain and not associated with sphincter disturbance. Magnetic resonance imaging of the spine demonstrated lesion affecting the 5th lumbar vertebrae invading the left pedicle and compressing the spinal canal. Results: Team did neural decompression, biopsy harvesting, and partial corpectomy with reconstruction of the affected lumbar vertebra (L5) followed by fixation by rods and screws. The patient showed relief of the radicular pain and back pain on VAS. Histopathological analysis of the biopsy showed evidence of giant-cell tumor (brown tumor). Parathyroid survey was done and showed normal calcium levels. By revising the literature, we claim that this present study is reporting the 10th case of brown tumor of lumbar spine in patient with primary hyperparathyroidism. Conclusion: The diagnosis of brown tumor of spine could be considered in patients with lytic spine lesions. (2019ESJ192) Background Data: Brown tumor is a lytic bone tumor and has variable symptoms according to the affected site. It is called brown as its characteristic brown color that believed to be occurred after accumulation blood, fibrous tissue and hemosiderin. Hyperparathyroidism can cause it whatever it is primary or secondary. It is rarely affects the spine and extremely rare compromises the spinal canal. Purpose: To describe a case presentation of brown tumor affecting the lumbar spine. Study design: A case report of brown tumor of the lumbar spine (5th lumbar vertebrae) Patients and Methods: Our case was a forty years old female patient presenting with persistent dull aching low back pain. She had a 5 month history of slowly progressive left lower limb radicular pain and not associated with sphincter disturbance. Magnetic resonance imaging of the spine demonstrated lesion affecting the 5th lumbar vertebrae that invading the left pedicle and compressing the spinal canal. Results: Under general anesthesia, prone position, low back midline skin incision and dissection, insertion of paired poly-axial screws at the level above (L4) and level below (S1) the affected vertebra (L5) was done. The team started by anchoring the rod in-between the screws in the right side then open left transpedicular corpectomy of L5 with excision much of the lesion that was dark red suckable mild vascular tissue. Formal L5 laminectomy was done followed by insertion of transpedicular polyaxial screw on right side only of L5 and insertion of bone cement while it was semi-solid in consistency to augment preservation of the vertebral height and fusion. Neurolysis of the spinal roots and completing the fixation system were done he lesion was partially excised. The patient showed relief of the radicular pain and back pain on VAS. Conclusion: The diagnosis of brown tumor of spine could be considered in patients with slowly progressive persistent back pain.

Calculation of Intervertebral Disc Pressure in the Thoracic and Lumbar Spine in Elderly Women with Kyphosis Using a Novel Musculoskeletal Model with Isolated Thoracic Vertebrae and Rib Cage

Background: Degeneration of the intervertebral disc is one of the causes of kyphosis. Several biomechanical studies have investigated the mechanisms of development of spinal deformity using simulation models. Realistic musculoskeletal models are helpful for investigating the pathophysiology and changes in internal forces in patients with kyphosis. However, the association between intervertebral disc pressure and kyphosis has not been fully elucidated to date. Purpose: To calculate intervertebral disc pressure in elderly women with kyphosis using a novel and precise thoracolumbar three-dimensional musculoskeletal model. Materials and Method: Ten female patients with a mean age of 80.0 ± 6.5 years who visited our hospital for medical examination of osteoporosis were included. The subjects were divided into the normal and kyphosis groups depending on their sagittal vertical axis. Intervertebral disc pressures in the thoracic and lumbar spines of subjects were analyzed by inverse dynamics analysis using a novel three-dimensional musculoskeletal model, and were compared between the groups. Result: Significant differences in lumbar lordosis (LL) were observed between the two groups. Furthermore, the kyphosis group was older and shorter. In the kyphosis group, the upper thoracic vertebrae (T1 - T6) showed significantly higher intervertebral pressure than the normal group. Conclusion: Intervertebral disc pressure in the thoracic and lumbar spines of patients with spinal deformities was evaluated using a novel thoracolumbar three-dimensional musculoskeletal model. Using this novel model with separated thoracic spine and modified muscle path reflecting actual physiological curvature, disc pressure closer to the realistic condition was obtained. Intervertebral disc pressure in the upper thoracic spine in the kyphosis group was significantly increased compared with that in the normal group. Moreover, intervertebral disc pressures in the upper thoracic spine correlated negatively with LL.

Influence of Thyroid-stimulating Hormone Suppression Therapy on Bone Mineral Density in Patients with Differentiated Thyroid Cancer: A Meta-analysis.

BackgroundThe effects of subclinical hyperthyroidism on bone mineral density (BMD) induced by thyroid-stimulating hormone (TSH) suppression therapy in patients with differentiated thyroid cancer (DTC) remains unclear. We conducted a meta-analysis to determine the influence of TSH suppression therapy on BMD.MethodsWe performed a systematic search to identify studies which included BMD measurement of femoral neck, total hip or lumbar spine in patients on TSH suppression therapy for DTC. Main outcome measures were difference of BMD of femoral neck, total hip or lumbar spine measured by dual energy X-ray absorptiometry between patients and controls.ResultsA systematic search yielded a total of 11 published controlled cross-sectional studies (including about 571 patients and 836 controls). TSH suppression therapy was associated with the lower BMD of total hip (weighted mean difference [WMD], −0.023; 95% confidence interval [CI], −0.047 to 0.000; P=0.050) and spine (WMD, −0.041; 95% CI, −0.057 to −0.026; P<0.001) in postmenopausal women with DTC, while it was not associated with that in premenopausal women and men with DTC.ConclusionsAlthough the included studies were limited by small numbers, results suggested possible association between chronic TSH suppression therapy and the lower BMD of spine and total hip in postmenopausal women (but not in premenopausal women and men) with DTC. A large, well-designed study with long-term follow-up would provide further insight into the influence of TSH suppression therapy and loss of BMD.

Radial MR Screen of the Sacroiliac Joints in the Lumbar Spine of Patients with Chronic Lower Back Pain

Magnetic resonance imaging (MRI) can reliably detect inflammation and structural changes in sacroiliac joints (SIJs) in patients with lower back pain (LBP). However, patients with LBP are usually referred for MRI of the lower back (e.g. lumbar spine LS), and imaging of the SIJs is rarely requested for these patients. The aim of this work is to use radial MRI as an additional screening technique for SIJ pathology presenting in lumbar spine patients with chronic LBP.

Pattern of Lumbar MRI Changes in Patients with Chronic Low Back Pain in a Tertiary Care Center

Introduction: Chronic low back pain (LBP) is a common cause of disability worldwide. Magnetic resonance imaging (MRI) is an excellent non-invasive imaging modality for morphologic evaluation of the lumbar spine in patients with chronic low back pain because of its high contrast resolution and lack of ionizing radiation. This study was done to see the patterns of MRI changes in patients with chronic low back pain in a tertiary care center in Western Nepal. Methods: This was a cross-sectional study conducted on patients presenting with chronic low back pain. Eleven MRI parameters were noted and analyzed. Chi square test and Fisher’s Exact test were employed to see the associations between the various MRI findings. Results: A total of 108 patients were evaluated during the study period. MRI changes were noted in over 95% of the cases. Degenerative changes were the most common cause of low back pain, disc bulge being the most common MRI finding. A significant association was found between radiculopathy and decreased lumbar lordosis and vertebral endplate changes. Conclusion: MRI is an invaluable tool in the evaluation of chronic LBP because of its high resolution and lack of ionizing radiation. Significant MRI findings are noted in most of the cases of chronic LBP, degenerative changes being the most common and ranging from congenital to malignant lesions.

Optimization of Surgical Care and Anesthesia in the Treatment of Multilevel Degenerative Diseases of the Lumbar Spine in Patients with Overweight and Obesity

Background: The provision of surgical care in the treatment of degenerative diseases of the lumbar spine in patients with obesity and obesity is associated with significant risks of anesthesia and the development of perioperative complications. Aims: to analyze the results of the introduction of a combination of surgical procedures and anesthesia in the treatment of multilevel degenerative diseases of the lumbar spine in patients with excessive body weight and obesity.Materials and methods: The results of surgical treatment of 86 patients were studied, 2 groups were identified. In the study group (SG, n=37), minimally invasive surgical techniques and original surgical approach, paravertebral musculature infiltration with bupivacaine with epinephrine, and multimodal anesthesia with dexmedetomidine were used. The comparison group (CG, n=49) consisted of patients who used the technique of traditional open transpedicular fixation in combination with the posterior interbody fusion without the above combination of surgical procedures and anesthesia. Observation and clinical evaluation was performed in the early (during hospitalization) and in the distant (on average 36 months) postoperative periods.Results: In SG there were no changes in hemodynamics and better results were obtained on the speed of recovery of psychomotor functions. The use of local anesthetics significantly reduced the local pain syndrome (p0.05) and the need for analgesics (p=0.002). Comparative analysis in the main group revealed significantly better results in indices of the duration of the operation [SG 145 (105; 155) min, CG 185 (100; 205) min; p=0.02], the volume of blood loss [SG 110 (90; 140) ml, CG 510 (390; 640) ml; p0.001], the activation time [SG 1 (1; 2) days, CG 3 (3; 4) days; p=0.01], the length of hospitalization [SG 10 (9; 11) days, CG 13 (12; 15) days; p=0,03], remote clinical parameters of the pain syndrome level from the visual analogue scale in the lower extremities [SG 3 (1; 4) mm, CG 9 (6; 14) mm; p=0.006] and the lumbar spine [SG 6 (4; 9) mm, CG 16 (11; 21) mm; p=0.001], functional state according to ODI [SG 8 (6; 10) points, CG 16 (12; 24) points; p=0.008], subjective satisfaction with the operation performed on the Macnab scale (p=0.01). The number of postoperative complications in SG was 8%, in CG ― 18% (p=0.006).Conclusions: Analysis of the results of the introduction of a combination of surgical and anesthetic support methods in the treatment of multilevel degenerative diseases of the lumbar spine in patients with overweight and obesity, including minimally invasive surgical techniques, infiltration of paravertebral muscles with bupivacaine and epinephrine, multimodal anesthesia with dexmedetomidine showed its high perioperative safety, low number of complications, as well as better and clinical outcomes in the early and late postoperative periods.

The Duration of the correction loss after removing cheneau brace in patients with adolescent idiopathic scoliosis

ObjectiveThe aim of the study was to evaluate the loss of truncal rotation over 54 hours after removing Chêneau brace. MethodsThe studied groups consisted of 39 girls aged 10–18 years old, diagnosed with adolescent idiopathic scoliosis (AIS) and treated with Chêneau brace (CAST) and 20 AIS girls aged 10–18 years old, not treated with bracing. Posterior-anterior radiographs were obtained from the clinical assessment of all subjects and were subsequently used to determine Cobb angles. The measurements of the angle of trunk rotation (ATR) were taken with the Scoliometer® and back-contour device during Adams forward bending test by the two evaluators. The changes in ATRs during 54 hours of observation were performed after the brace had been taken off (0, 2, 24, 30, 48 and 54 hours after debracing). This was described using VATR variable, defined as the change in the absolute Scoliometer® readings in the time intervals against the time interval Δt between the measurements. During back-contour assessment the differential factor (kra) has been used for the digital analysis. The changes in kra over 54 hours of observation were expressed as Vkra factor, defined as the difference in the absolute value of the amplitude differential factor (kra) in the time intervals against the time interval Δt between the measurements. ResultsThe highest changes were observed in the thoracic as well as in lumbar spine in patients with Cobb angle ≥30°, axial rotation of the apical vertebrae within 5–15°, Risser sign 0–2. The biggest change in the trunk rotation after Chêneau brace had been taken off was noted within the first two hours of observation. ConclusionThe patients should be advised to take the brace off for a minimum of two hours before the scheduled x-ray, to allow full relaxation of the trunk in order to obtain reliable radiological images of the deformation. Level of EvidenceLevel III Therapeutic study.

Calcitriol treatment in patients with low vitamin D levels

Active vitamin D analogs may have larger impact in decreasing bone loss and fracture rate compared to cholecalciferol in osteoporosis. However, their effects in the treatment of vitamin D deficiency compared to cholecalciferol are not clear. The aim of the present study is to compare the effects of cholecalciferol and calcitriol on bone mineral metabolism and bone mineral density in pre- and postmenopausal women with vitamin D deficiency. This was a 6-month prospective, open-label, controlled clinical trial. Eligible 120 participants were pre- and postmenopausal women diagnosed with vitamin D deficiency. Forty-three subjects (group 1) received 1000IU of cholecalciferol and 1g of calcium daily. The other 77 subjects (group 2) received 0.5μg calcitriol in addition to 400IU of cholecalciferol and 1g of calcium daily. Oral vitamin D supplementation did not increase bone mineral density after 6months of intervention in group 1. On the other hand, bone mineral density at the lumbar spine increased from 0.809 ± 0.172 to 0.848 ± 0.161g/cm2 in group 2 patients (p < 0.017 vs baseline). Oral daily calcitriol was associated with a significant increase in bone mineral density at the lumbar spine in patients with low vitamin D, elevated PTH, and osteoporosis.

Plain radiograghs of lumbar spine in patients with low back pain.

Low back pain (LBP) is one of the common symptoms which bring patients to hospital and ultimately to radiology department for medical assistance. Plain radiographs of lumbar spine are usually the initial imaging tools requested by clinicians. The objective of this study is to evaluate commonest finding in patients with LBP to guide physicians for improved management. This work was a retrospective study. Plain films of these patients with LBP at the University of Nigeria Teaching Hospital, Enugu, were assessed by two radiologists. Findings documented and analyzed using IBM'S SPSS 22. Association was determined using chi-square with level of significance, p < 0.05. Total number of radiographs reviewed was 333. One hundred and eighty-three (55.0%) patients were females. Age ranged from 14 to 101years. Mean age of 53.4 ± 15.9years. Disc space was normal in majority (55.3%, 184/333) of patients; narrowing was observed in most others (43.2%, 144/333), about half of the narrowing occurring along with vacuum phenomenon. Osteophytes were commonest finding in a total of 284/333 (85.3%) existing alone or in combination with other findings. Proportion of patients with osteophytes was highest in sixth to eighth decade of life (98.8% of 61-80 age group), followed by 41-60 age group (92.9%). This association between age group and the presence of osteophytes was statistically significant (p < 0.000). Anterior vertebral body was affected in 85.0% (284/333) of patients. Osteophytes are common radiologic features in LBP. Anterior vertebral body is most affected. It is commoner in the older age group. Plain radiograph is an invaluable imaging tool in the management of LBP in this part of the world.