Mediolateral Plane Research Articles

The Tibial Tunnel Size Relative to the Proximal Tibia Affects the Tibial Tunnel Widening in Anatomical Anterior Cruciate Ligament Reconstruction.

The impact of the bone tunnel size relative to body size on clinical results in anterior cruciate ligament (ACL) reconstruction remains unclear. This study aimed to assess the morphological alteration of the tibial tunnel aperture and relationship between the tibial tunnel size relative to the proximal tibia among the tibial tunnel widening (TW) and clinical results following ACL reconstruction. This study comprised 131 patients who had undergone anatomical ACL reconstruction utilizing bone-patellar tendon-bone autografts. The morphology and enlargement of the tibial tunnel were examined via three-dimensional computed tomography 1 week and 1 year postoperatively. The anteroposterior (AP) and mediolateral (ML) positions were determined as a percentage relative to the proximal AP and ML tibial dimensions, respectively. Clinical assessment was conducted 2 years postoperatively. The association between the primary tibial tunnel size among TW and clinical outcomes was examined. The tibial tunnel significantly migrated posterolaterally. The ML diameter significantly widened; however, the AP diameter did not exhibit widening. AP widening was associated with the AP diameter of the primary tibial tunnel (r = -0.482, p < 0.01), and ML widening correlated with the ML diameter of that tunnel (r = -0.478, p < 0.01). However, there was no significant correlation observed between the primary tibial tunnel size and clinical outcomes. The tibial tunnel migrated and enlarged laterally in the ML plane, but did not enlarge in the AP plane. The primary tibial tunnel diameter relative to the proximal tibia negatively correlated with the tibial TW in the AP and ML planes. Level of evidence: level IV.

Comparison of Bending Stiffness between String of Pearls Plate-Bone Substitute Constructs with and without Bending Tees in a Fracture Gap Model

Abstract Objective The aim of this study was to compare the bending properties of String of Pearls plate-bone substitute constructs with and without bending tees in the nodes over a simulated fracture gap. It is hypothesized that the constructs with tees will have higher bending stiffness. Study Design Acetal polymer tubes and 12-hole, 3.5-mm String of Pearls plates were used to create plate-bone substitute constructs simulating stabilization in a bridging fashion over a 45-mm gap. Twenty-four constructs were made with 12 containing tees in the nodes over the fracture gap. Single-cycle load-to-failure 4-point bending was performed in mediolateral and craniocaudal planes. Bending stiffness was compared with a t-test (p &lt; 0.05). Results All plate-bone substitute constructs had a permanent loss of structural integrity via plastic deformation of the plate. The bending stiffness (mean ± standard deviation) of the craniocaudal group was 59.11 ± 1.98 N/mm with tees and 59.25 ± 1.69 N/mm without tees (p = 0.88). In the mediolateral group, the bending stiffness was 43.17 ± 0.75 N/mm with tees and 41.09 ± 0.91 N/mm without tees (p = 0.0042). Conclusion In 4-point bending, the plate-bone substitute constructs with tees had equivalent bending stiffness in the craniocaudal plane and increased bending stiffness in the mediolateral plane. However, with a small absolute difference in values, the clinical significance is unclear. Future studies for cyclic bending, torsional, and axial compression tests should be performed to further investigate the value of tees in the nodes over a comminuted or gap fracture repaired in a bridging fashion.

Differences in Trunk Acceleration-Derived Gait Indexes in Stroke Subjects with and without Stroke-Induced Immunosuppression.

Background: Stroke-induced immunosuppression (SII) represents a negative rehabilitative prognostic factor associated with poor motor performance at discharge from a neurorehabilitation unit (NRB). This study aims to evaluate the association between SII and gait impairment at NRB admission. Methods: Forty-six stroke patients (65.4 ± 15.8 years, 28 males) and 42 healthy subjects (HS), matched for age, sex, and gait speed, underwent gait analysis using an inertial measurement unit at the lumbar level. Stroke patients were divided into two groups: (i) the SII group was defined using a neutrophil-to-lymphocyte ratio ≥ 5, and (ii) the immunocompetent (IC) group. Harmonic ratio (HR) and short-term largest Lyapunov's exponent (sLLE) were calculated as measures of gait symmetry and stability, respectively. Results: Out of 46 patients, 14 (30.4%) had SII. HR was higher in HS when compared to SII and IC groups (p < 0.01). HR values were lower in SII when compared to IC subjects (p < 0.01). sLLE was lower in HS when compared to SII and IC groups in the vertical and medio-lateral planes (p ≤ 0.01 for all comparisons). sLLE in the medio-lateral plane was higher in SII when compared to IC subjects (p = 0.04). Conclusions: SII individuals are characterized by a pronounced asymmetric gait and a more impaired dynamic gait stability. Our findings underline the importance of devising tailored rehabilitation programs in patients with SII. Further studies are needed to assess the long-term outcomes and the role of other clinical features on gait pattern.

The footprint mismatch of cervical disc arthroplasty comes from degenerative factor besides ethnic factor

A mismatch in footprints of cervical total disc arthroplasty (CTDA) implants occasionally occurred in Asian population and it had been attributed solely to ethnic factor. Yet, cervical degeneration process may play a role. Our purpose was to compare the cervical vertebra morphometric data with and without degeneration. The study included patients with CT scans of cervical spine from our hospital between January, 2019, and September, 2021. The total cervical degenerative index (TCDI) of each patient were collected by adding CDI score for 5 disc-levels. Patients were categorized into normal (TCDI 0–5) and degeneration groups (TCDI 6–60). Various measurements of the C3–C7 vertebral body and endplate were taken. Forty-nine patients in the normal group and 55 in the degeneration group were included. No significant difference was noted in gender, BH, BW, or BMI except age and TCDI (p < .001). During degeneration, disproportional endplate size changes were observed, with an increment ratio of 12–20% in the anteroposterior and 5–17% in the mediolateral plane throughout C3–C7, while vertebral body height remained constant. In conclusion, degeneration process, besides ethnic factor, causes the endplate size and shape mismatch. This information can help spine surgeon choose appropriate implants in CTDA surgery.

The Effect of Different Sensory Perturbations on Postural Control and Fall Risk in Benign Paroxysmal Positional Vertigo Patients.

Benign paroxysmal positional vertigo (BPPV) patients may experience balance problems in various environmental conditions other than positional dizziness. Therefore, there is a need to investigate the postural control abilities and the ability to use sensory inputs in BPPV patients in different conditions. The aim of this study was to examine the postural control performance of middle-aged adult BPPV patients in easy and difficult balance tasks, the effect of vestibular stimulation on the maintenance of balance, and the risk of falling, by posturographic evaluation in various conditions. A total of 26 patients diagnosed with posterior canal BPPV and 26 controls were included in the study. Sensory Organization Test (SOT), Vestibular Stimulation Test (VST), and fall risk assessment (FRA) were applied to the participants, respectively. Significant difference was observed in SOT medio-lateral (ML) plane in Conditions 2 and 5 (p < .05). A significant difference was observed in the vestibular score in the SOT ML plane. No significant difference was observed in VST test scores (p > .05). In the FRA test, a significant difference was observed in the energy and gain parameters in the anterio-posterior plane (p < .05). The current study examined postural control abilities of patients with BPPV in extensive external conditions and in both planes, using various sensory perturbations and stimulation. It was thought that while BPPV patients were in the active phase of the disease, their postural control skills in the ML plane decreased and they might be at risk of falling.

Changes in trunk postural control with different types of mounts with relevance for hippotherapy

BackgroundHippotherapy uses horseback riding movements for therapeutic purposes. In addition to the horse's movement, the choice of equipment and types of positions are also useful in the intervention. Trunk postural control demands can be manipulated through varying mounting materials and patient positioning on the horse. The quantification of trunk dynamic parameters under the interaction of the different types of riding material and the position variations act upon trunk postural control provides insight into how children with neurotypical development respond to a similar hippotherapy session. This study aimed to evaluate the postural control of the trunk of children with neurotypical development when the riding materials and positioning of the feet and hands support were modified during horse riding. MethodsFifteen children with neurotypical development, aged 6–12 years old, of both sexes, participated in a hippotherapy session. Postural control was measured by the mean amplitudes of oscillation of the lumbar (L5) and thoracic (T5) segments in the mediolateral, anteroposterior and rotational planes with a portable inertial measurement system, in situations using the saddle or blanket, hands resting on the straps or thigh and feet free or supported on the stirrup. ResultsDifferences were observed in lumbar and thoracic oscillation in the mediolateral direction. Values were significantly higher with the use of the blanket when the hands were on the handle and feet in the stirrups, compared to the use of the saddle. When using the blanket and feet positioned in the stirrups, statistical differences with higher values occurred with the hands on the handle compared to the thigh positioning. ConclusionThe use of the blanket equipment associated with the support of the hands on the handles and feet on the stirrups produces greater mediolateral oscillation in the subjects. DescriptorsBalance. Stability. Children. Hippotherapy. Kinematics.

Evaluation of the Stability of Internal Fixation Constructs in a Low Distal Tibia Extra-articular Cadaveric Fracture Model: A Comparative Biomechanical Study.

Introduction Despite the recent advances in implant design, the choice of an internal fixation modality for extra-articular distal tibia fractures remains controversial, and there is sparse literature comparing the stability of intramedullary nails and locked plates for such fractures. Hence, we conducted a biomechanical study on an AO type 43A3 tibia fracturecadaveric model stabilized by four different constructs, viz., intramedullary (IM) interlocking nail, anteromedial plate, anterolateral plate, and posterior plate.An AO type 43A3 fracture is defined as an extra-articular fracture of the distal tibia with metaphyseal comminution. Methods A biomechanical comparative study on formalin-preserved human cadaveric tibiae was undertaken; a total of four groups were tested, with eight bones in each group. Out of the 32 cadaveric tibiae, 19 bones belonged to male cadavers, and 13 bones belonged to female cadavers. All bones were dissected from age-appropriate cadavers and fixed with an implant, followed by the creation of a 1 cm osteotomy to simulate an AO type 43A3 fracture. All fixation constructs were subjected to three-point bending tests in the anteroposterior (AP) and mediolateral (ML) planes. Three parameters, viz., bending stiffness, peak fracture gap angle, and neutral zone, were evaluated on the load-displacement curves. Afixation construct was deemed biomechanically stable if it had a highbending stiffness, a low neutral zone (inherent toggle in the construct by its weight), and a low peak fracture gap angle. Results Out of the four implants tested, locked IM nails exhibited the maximum biomechanical stability in terms of higher bending stiffness, smaller peak fracture gap angle, and smaller neutral zones. The IM nail exhibited the highest bending stiffness in the AP plane, and the anterolateral plate had the lowest bending stiffness, and the difference was statistically significant (p= 0.032).In the AP plane, the anterolateral plate exhibited a bending stiffness of 1.51 ± 0.69 Nm/degree, whereas the intramedullary nail exhibited a bending stiffness of 2.34 ± 0.81 Nm/degree, and the posterior locked plate had a bending stiffness of 1.57 ± 0.44 Nm/degree. In the ML plane, the anterolateral plate exhibited the highest neutral zone as compared to the intramedullary nail, which had the lowest neutral zone, and the difference was statistically significant (p = 0.019). The intramedullary nail exhibited the lowest neutral zone of 0.46 ± 0.31 degrees, whereas the posterior locked plate exhibited a neutral zone of 0.78 ± 0.43 degrees in the ML plane. The anterolateral plate exhibited a neutral zone of 1.43 ± 1.00 (expressed as mean ± SD) degrees in the mediolateral plane. Conclusion Our biomechanical study supports the recommendations of using a locked intramedullary nail for AO type 43A3 fractures. We concluded that the anterolateral plate construct exhibited the least biomechanical stability, in terms of lower AP bending stiffness and higher neutral zone. If the surgeon must choose a locked plating technique for any reason, the anterolateral locking plate should be avoided. If plating is at all required, we can recommend both anteromedial and posterior locked plating as biomechanically sound options.

The mechanical response to hockey-specific running gait: implications for the objective monitoring of (p)rehabilitation

ABSTRACT Field hockey is characterized by a unique dribbling position which has been associated with a prevalence of low back pain and lumbar injury. To quantify the biomechanical response of the hockey-specific running gait, twelve field hockey players completed treadmill running at speeds of 6, 9 and 12 km·hr−1 with a normal running gait and whilst manipulating the hockey stick to replicate dribbling. Mechanical loading was quantified using tri-axial accelerometery at L4, and muscular activity was measured for biceps femoris (BF), gluteus medius (GM) and quadratus lumborum (QL) of each limb. Running with the stick elicited greater mechanical loading in the medio-lateral (p = 0.001) and antero-posterior (p = 0.003) planes, and increased peak (p = 0.004) and mean (p = 0.002) EMG response of QL (p = 0.004). The greater planar mechanical loading and QL activation in response to hockey-specific running technique support epidemiological observations of lower back pain prevalence. The sensitivity of uni-axial mechanical loading to the hockey-specific running posture provides an efficacious means of objectively monitoring mechanical loading in-vivo, whilst the QL activation response has implications for (p)rehabilitative interventions. Running posture and speed can be considered as discrete progressions when considering training load.

Effects of free versus restricted arm movements on postural control in normal and modified sensory conditions in young and older adults

The purpose of this study was to explore the effects of arm movements on postural control when standing under different sensory conditions in healthy young and older adults. Fifteen young (mean ± SD age; 21.3 ± 4.2 years) and 15 older (mean ± SD age; 73.3 ± 5.0 years) adults completed the modified Romberg test, which uses four task manipulations (i.e. eyes open and eyes closed on a firm and foam surface) to compromise the fidelity of sensory feedback mechanisms. Each participant completed the tasks under two arm movement conditions: restricted and free arm movements. Centre of pressure (COP) range and frequency were calculated to characterise postural performance and strategy, respectively. Older adults showed greater COP range with restricted compared to free arm movements during all modified sensory conditions, with these effects most prominent in the medio-lateral (ML) plane (all p < .05, Cohen's d = 0.69–1.61). Compared to the free arm movement condition, there was an increase in ML displacement and frequency when arm movements were restricted during only the most challenging (i.e. vestibular dominant) task in young adults (all p < .05, d = 0.645–0.83). Finally, main age effects for the arm restriction cost (p < .05) indicates a greater reliance on an upper body strategy in older compared to young adults, independent of sensory availability/accuracy. These findings indicate that older adults compensate for the loss of accuracy in sensory input by increasing reliance on upper body movement strategies.

The synergy between AI and radiologist in advancing digital mammography: comparative study between stand-alone radiologist and concurrent use of artificial intelligence in BIRADS 4 and 5 female patients

BackgroundRecent significant advancements in speed and machine learning have profoundly changed artificial intelligence (AI). In order to evaluate the value of AI in the detection and diagnosis of BIRADS 4 and 5 breast lesions visible on digital mammography pictures, we compared it to a radiologist. The gold standard was tissue core biopsy and pathology. A total of 130 individuals with 134 BIRADS 4 or 5 mammography lesions were included in the study, and all relevant digital mammography pictures were exported to an AI software system.ObjectivesThe goal of this investigation was to determine how well artificial intelligence performs in digital mammography when compared to a radiologist in identifying and diagnosing BIRADS 4 and 5 breast lesions.MethodsA total of 134 BIRADS 4 and 5 breast lesions in 130 female patients were discovered using digital mammography on both the craniocaudal and mediolateral oblique planes. All mammograms were transferred to an AI software system for analysis, and the results were compared in accordance with the histopathological results, which served as standard of reference in all lesions.ResultsArtificial intelligence was found to be more accurate (90.30%) than radiologist (82.84%) and shows higher positive predictive value (94.5%) than radiologist (82.8%) regarding suspecting malignancy in digital mammography with BIRADS 4 and 5 lesions, while the radiologist achieved higher sensitivity (100%) than AI (93.7%) in detecting malignancy in BIRADS 4 and 5 lesions.ConclusionsRadiologist was found to be more sensitive than AI in detecting malignancy in BIRADS 4 and 5 lesions but AI had a higher positive predictive value. However, specificity as well as negative predictive value could not be assessed for the radiologist, hence could not be compared with AI values because the inclusion criteria of the study did not include BIRADS 1, 2 and 3 so benign-looking lesions by digital mammography were not involved to measure specificity and negative predictive values. All in all, based on the available data, AI was found to be more accurate than radiologist regarding suspecting malignancy in digital mammography. AI can run hand in hand with human experience to give best health-care service in screening and/or diagnosing patients with breast cancer.

Tri-axial loading response to anti-gravity running highlights movement strategy compensations during knee injury rehabilitation of a professional soccer player

ABSTRACT Anti-gravity treadmills have been used in rehabilitation to manipulate exposure to loading and to prescribe return to outside running. Analysis is typically restricted to the vertical plane, but tri-axial accelerometry facilitates multi-planar analysis with relevance to injury mechanism. In this case a professional male soccer player, 4 weeks post-operative surgery to repair a medial meniscectomy, 8 months after Anterior Cruciate Ligament reconstruction to the same knee, completed anti-gravity treadmill running at 70–95% bodyweight (BW) at 5% increments. Tri-axial accelerometers were placed proximal to the Achilles tendon of the injured and healthy leg, and at C7. The planar acceleration at touchdown highlighted an increase at 85% BW, identifying 70% and 85% BW as discrete loading progressions. C7 (3.21 ± 0.68 m·s−2) elicited lower (P < 0.001) vertical acceleration than the lower limb (9.31 ± 1.82 m·s−2), with no difference between limbs suggesting bilateral symmetry. However, in the medio-lateral plane the affected limb (−0.15 ± 1.82 m·s−2) was exposed to lower (P = 0.001) medio-lateral acceleration than the non-affected limb (2.92 ± 1.35 m·s−2) at touchdown, indicative of bilateral asymmetry. PlayerLoad during foot contact was sensitive to accelerometer location, with the affected limb exposed to greater loading in all planes (P ≤ 0.082), exacerbated at 90–95% BW. Tri-axial accelerometry provides a means of assessing multi-planar loading during rehabilitation, enhancing objective progression.

Dynamic sitting in infants: Limits of stability

BackgroundLimits of stability—defined by the maximum distances a person is willing to reach without falling or changing the base of support—are measures of dynamic balance. Research question: What are infants’ sitting stability limits in the forward and right directions? MethodsTwenty-one 6- to 10-month old infants participated in this cross-sectional study. To incentivize infants to reach beyond arm’s length, caregivers began by holding a toy close to their infants at shoulder height. Caregivers then moved the toy farther away as infants tried to reach for it until infants lost balance, placed their hands on the floor, or transitioned out of sitting. All sessions were conducted via Zoom™ and video-recorded for further analyses using DeepLabCut for 2D pose estimation and Datavyu to determine timings of the reach and to code infants’ postural behaviors. ResultsInfants’ trunk excursions in the anterior-posterior plane (for forward reaches) and medio-lateral plane (for rightward reaches) represented their stability limits. Most infants ended the reach by returning to their original sitting position; however, infants with higher Alberta Infant Motor Scale (AIMS) scores transitioned out of sitting and infants with lower AIMS scores sometimes fell (mostly during rightward reaching). Trunk excursions were correlated with months of sitting experience. Rightward trunk excursions were also correlated with AIMS scores and age. Overall, infants’ trunk excursions were larger in the forward than in the right direction, and such discrepancy was consistent across infants. Lastly, the more often infants adopted movement strategies with their legs (e.g., bending the knees), the greater the trunk excursion they attained. SignificanceSitting control entails learning to perceive the boundaries of stability limits and acquiring anticipatory postures to suit the needs of the task. Tests and interventions that target sitting stability limits could be beneficial for infants with or at risk of motor delays.

The effects of optic flow on postural stability: Influence of age and fall risk

BackgroundOptic flow provides dynamic information relating to body position and motion with respect to visual frames of reference. This study investigated the effects of optic flow stimuli presented in four directions on postural stability in young and older adults. MethodsTwenty-five young (20–40 years) and 51 older (≥65 years) people participated in this study, with the older group classified into low fall risk (n = 27), and high fall risk (n = 24) sub-groups. While standing in a dark room, participants viewed static scattered white dots for 30 s, followed by 30 s periods of optic flow consisting of white dots “moving” in one of four flow directions, randomised: radial expansion and contraction, circular anti-clockwise and clockwise. Centre of pressure (CoP) position, postural sway in anteroposterior (AP) and mediolateral (ML) axes, and muscle activity of tibialis anterior (TA), gastrocnemius medialis (GM) and tensor fascia latae (TFL) were recorded. ResultsAcross groups, the four optic flow stimuli induced increased AP sway and three of the four optic flow stimuli induced increased ML sway, with concomitant increases in muscle activity, indicating optic flow stimuli induced a generalised destabilising, rather than a direction-specific, effect. Only one optic flow condition (radial contraction) induced a change in average CoP position, and this may reflect the adoption of a protective stance position to avoid a backward fall. Optic flow destabilised postural control more in older people compared with younger people, and radial expansion stimuli destabilised ML postural control more in the older high fall risk group compared with the older low fall risk group. ConclusionOptic flow stimuli have a generalised destabilising effect on postural control across groups as shown by non-directional specific increases in postural sway and muscular activity. Optic flow stimuli have a greater impact on postural stability in older compared with younger adults and this is more pronounced in the ML plane for older people at increased risk of falls.

Dynamic postural control in individuals with and without chronic ankle instability-do the modified star-excursion balance test and jump-landing stabilization have the same control mechanism?

ObjectiveTo examine the relationship between two dynamic postural tasks in subjects with and without chronic ankle instability (CAI). DesignCross-sectional study. SettingBiomechanics lab. ParticipantsThirty subjects with CAI and 30 healthy controls. Main outcome measurePerformance of two dynamic postural control tests: the modified Star-Excursion Balance Test (mSEBT) and an assessment of a single limb jump-landing on a force plate that yielded two outcomes: time to stabilization (TTS) and the absolute average force in the mediolateral plane during the first 0.4 s after landing (AAFML). ResultsIn the CAI group, a significant correlation was found between the mSEBT score and the AAFML (ρ = −0.54, p < 0.01), but not between the mSEBT or TTS or between the AAFML and the TTS. However, in the control group, a significant correlation was found between AAFML and the TTS (ρ = 0.43, p < 0.05), but not between the mSEBT and TTS or between the mSEBT and AAFML. ConclusionThese results suggest that there is no association between the different dynamic balance tasks. The different pattern of association in individuals with CAI may indicate altered central neural control. Clinicians and researchers should therefore not use a single task to assess dynamic postural control.

Effects of Anaerobic Fatigue Induced by Sport-Specific Exercise on Postural Control in Highly-Trained Adolescent Road Cyclists

The aim of this study was to evaluate whether and how anaerobic fatigue induced by sport-specific exercise affects the postural control of highly-trained adolescent road cyclists. Twenty-three male athletes, aged 15–18 years, were included in the study. Postural control was assessed using the pedobarographic platform (bipedal upright stance, sequentially, with eyes open (EO) and closed (EC) for 60 s each, with a 30 s interval), before and 3 min after a 30 s all-out effort performed on the ergometer. The results showed significant increases in the 95%-confidence ellipse area (p-value 0.000 and 0.001 for EO and EC, respectively), as well as centre-of-pressure (CoP) range displacement in the anteroposterior (p-value 0.000 for both EO and EC) and mediolateral (p-value 0.011 and 0.001 for EO and EC, respectively) planes. In addition, a significant decrease in CoP mean sway frequency was observed (p-value 0.000 and 0.001 for EO and EC, respectively), but no changes were noted in CoP mean velocity (p-value 0.316 and 0.670 for EO and EC, respectively). In our study, it has been indicated that anaerobic fatigue induced by sport-specific exercise deteriorates postural control in adolescent cyclists. Moreover, cycling training may affect the quality of postural corrective reactions occurring in response to anaerobic fatigue.

"Insert flipping technique:" An effective way of restoring segmental lordosis and disc height with tall bullet cages.

The study design was a retrospective study. The objectives of the present study are dual; to describe a simple and effective way of restoring intervertebral disc (IVD) height by the "Insert Flip Technique" of cage insertion and to demonstrate effective restoration of IVD height and segmental lordosis (SL) and their influence on the functional outcome postoperatively. IVD height and SL were recorded pre- and postoperatively. Each motion segment was instrumented with pedicle screws to allow segmental stabilization. Patients were called for follow-up at 6 weeks, 3 months, and 1 year postoperatively and were assessed clinically for back pain and leg pain (VAS and Oswestry Disability Index scores recorded).The bullet cages are designed such that they are lordotic in the superior-inferior plane and neutral in the mediolateral plane. Usually, the cage is inserted with superior and inferior surfaces of the cage impacting against superior and inferior end plates of the adjacent vertebral body. However, with the proposed technique, the cages were inserted such that the narrower mediolateral surfaces of the cage engaged with superior and inferior vertebral end plates. The cage was then flipped within the disc space such that the superior-inferior surfaces of the bullet cage impacted against the superior and inferior end plates of the vertebral body to create desired lordosis. There was a significant improvement seen in the postoperative Cobb's angle and disc height after placement of a tall bullet cage compared to the preoperative Cobb's angle and disc height. This modification of technique helped in gaining lordosis with taller bullet cages in minimally invasive surgery transforaminal lumbar interbody fusion with no/minimal complication and also reduced the need for bone resection during insertion of the cage.

The Effect of an Overhead External Load Lifting and Lowering on Dynamic Postural Control in Subgroups of Low Back Pain.

Understanding postural control in low back pain (LBP) subgroups can help develop targeted interventions to improve postural control. The studies on this topic are limited. Therefore, the primary purpose of this study was to compare the postural control of LBP subgroups with healthy individuals during overhead load lifting and lowering. In this cross-sectional study, the participants were 52 with LBP and 20 healthy. The LBP patients were classified based on the O'Sullivan classification system into 21 flexion patterns and 31 active extension patterns. The participants lifted the box from their waists to their overheads and lowered it to their waists. Changes in postural control parameters were measured with a force plate system. The results of the analysis of variance showed that during load lifting, the mediolateral phase plane (p = .044) and the mean total velocity (p = .029) had significant differences between flexion patterns and healthy. Also, the load-lowering results showed that active extension patterns, compared with healthy, had significant differences in the anteroposterior-mediolateral phase plane (p = .042). The patients showed less postural sway than the healthy. The results in this work highlight the importance of identifying the homogenous subgroups in LBP and support the classification of heterogeneous LBP. Different subgroups exhibit different postural control behaviors. These behaviors can be due to the loading of various tissues during different tasks.

Energy analysis of gait in patients with down syndrome

Backgroundthe primary aim of this study is to analyse the energy parameters of patients with Down syndrome compared to a control group and secondly to verify whether the sport activity leads to differences in energy expenditure. Methods3 groups of subjects were identified: 8 healthy subjects and 147 subjects with Down syndrome, of whom 14 played sports at least once a week. An energy index was calculated, given by the ratio between potential and kinetic energy. Next, kinetic ad potential energy parameters were extrapolated at 60% of the gait cycle (propulsion phase). FindingsDown syndrome group was compared with the control group and emerged that the energy index was higher in the first one. No changes were found between Down syndrome and Down syndrome Sport groups. The analysis of the energy parameters showed that all parameters, except the medio-lateral kinetic energy, were higher in the control than in the Down syndrome groups. The potential energy, medio-lateral kinetic energy, and vertical were higher in the Down syndrome Sport group than in the Down syndrome group. The kinetic energy and the mean velocity were higher in the control group than in Down syndrome Sport group while the medio-lateral kinetic energy was lower. Interpretationsport modified the parameter of potential energy but not that of kinetic energy, which continued to be different compared to the healthy group and increased the oscillations in the medio-lateral plane, which were double compared to Down syndrome group. The increase in potential energy, found to be almost equal to that of control group, indicates an increase in vertical oscillations. This could be because subjects who practise sports have stronger muscles that allow a greater push-off ability, which therefore increases their potential energy.

Evaluation of postural stability and vestibulo-ocular reflex in adults with chronic suppurative otitis media

PurposeTo evaluate the vestibulospinal reflex and vestibulo-ocular reflex (VOR) in patients with chronic suppurative otitis media (CSOM) using posturography and the video head impulse test (vHIT).MethodsSixty-five patients with CSOM and 65 healthy participants as controls were included. Patients with CSOM were instructed to complete the dizziness handicap inventory (DHI). All participants underwent otoscopy, pure-tone audiometry, posturography sensory organization test (SOT), and vHIT.ResultsPatients with CSOM exhibited a high prevalence of dizziness. The CSOM group had poor SOT vestibular scores compared to the control group. Patients with CSOM had worse sways in the antero-posterior and mediolateral planes. The CSOM group was divided into two subgroups according to the type of hearing loss. SOT vestibular scores were significantly poorer in the mixed hearing loss group than those in the conductive hearing loss group. We found a positive correlation between disease duration and poor SOT vestibular scores. Moreover, poor SOT vestibular scores correlated with high DHI scores. We found abnormalities in the vHIT results in the CSOM group in the form of low VOR gain and corrective saccades.ConclusionOur study provides clinical evidence of dizziness, poor postural control, and VOR abnormalities in patients with CSOM. The presence of sensory elements of hearing loss in patients with CSOM appears to be positively associated with vestibular dysfunction.

Gender Differences in Postural Stability in a Cohort of Adolescent Age

Daily tasks necessitate improved locomotive abilities and movements, which are determined by an individual’s balance control. Body postures allows us to stay in a stable and balanced stance without falling. The present study examines postural stability in males and females using centre of pressure metrics in two planes for the adolescent group. Force data was collected in three directions (Fx, Fy, and Fz) using a standard force platform (SENSIX force plates) under two support and two visual conditions, including eyes-open, stand-up on two limbs (OB), eyes-closed, stand-up on two limbs (CB), eyes-open, stand-up on single limb (OO), eyes-closed, stand-up on single limb (CO). The CoP was determined in both the antero-posterior and medio-lateral planes. Two features were derived from the CoP data: sway and average velocity in both planes. The findings demonstrate that for all experimental conditions in both directions, CoP characteristics (sway and velocity) of male gender were significantly (p<0.05) higher than female gender. This work concludes that males have higher postural stability than females of similar age, indicating that hormonal variables such as thyroid, estrogens, and others reduce postural stability.