Spinal Mobility Research Articles

The Impact of Surgical Techniques in Patients with Rectal Cancer on Spine Mobility and Abdominal Muscle Strength-A Prospective Study.

Simple SummaryThe aim of our study was to evaluate the spine joint mobility, muscle strength and chest mobility in patients undergoing surgery for colorectal cancer following abdominoperineal resection, or laparoscopic or open resection of the rectum. The studied patients were examined three times: prior to surgery, three months after surgery and six months after surgery. Three months after surgery, all study groups showed a reduction in the range of spine joint mobility, reduction in chest mobility and a reduction in the rectus abdominis and oblique muscle strength. Six months after surgery, an improvement was observed in terms of mobility and muscle strength. The dynamics of improvement were the greatest in patients undergoing laparoscopic anterior resection.The aim of this non-randomized study was to evaluate the impact of spine joint mobility and chest mobility on inhalation and exhalation, and to assess the abdominal muscle strength in patients undergoing surgery for colorectal cancer with one of the following methods: anterior resection, laparoscopic anterior resection or abdominoperineal resection. In patients who were successively admitted to the Department of Surgical Oncology at the Oncology Center in Bydgoszcz, the impact of spine joint mobility, muscle strength and chest mobility on inhalation and exhalation wasassessed three times, i.e., at their admission and three and six months after surgery. The analysis included 72 patients (18 undergoing abdominoperineal resection, the APR group; 23 undergoing laparoscopic anterior resection, the LAR group; and 31 undergoing anterior resection, the AR group). The study groups did not differ in terms of age, weight, height, BMIor hospitalization time (p > 0.05). Three months after surgery, reductions in spine joint mobility regarding flexion, extension and lateral flexion, as well asreductions in the strength of the rectus abdominis and oblique muscles, were noted in all study groups (p < 0.05). In comparison between the groups, the lowest values suggesting the greatest reduction in the range of mobility were recorded in the APR group. Surgical treatment and postoperative management in colorectal cancer patients caused a reduction in spine mobility, abdominal muscle strength and chest mobility. The patients who experienced those changes most rapidly and intensively werethose undergoing abdominoperineal resection.

Comparison of the effectiveness of conventional physical therapy and extracorporeal shock wave therapy on pain, disability, functional status, and depression in patients with chronic low back pain.

The aim of this study was to compare the effectiveness of conventional physical therapy (transcutaneous electrical nerve stimulation, hot pack, and therapeutic ultrasound) and extracorporeal shock wave therapy (ESWT) on pain, disability, functional status, and depression in patients with chronic low back pain (LBP). Ninety-one patients with chronic LBP were included in the study and randomized to groups that received ESWT or conventional physiotherapy; of these, 70 completed the study (37 males, 33 females; mean age: 46.4±13.3 years; range, 18 to 65 years). Outcome measures included the Visual Analog Scale, the pressure pain algometer, Oswestry Disability Index (ODI), Health Assessment Questionnaire (HAQ), fingertip-to-floor distance, and the Beck Depression Inventory. The assessments were made before treatment and at the first and 12th weeks after treatment. Extracorporeal shock wave therapy was more effective than conventional physical therapy in terms of Visual Analog Scale scores, the pressure algometer, ODI, HAQ, and fingertip-to-floor distance at the first and 12th week. Extracorporeal shock wave therapy is superior to conventional physical therapy in terms of improving pain, spinal mobility, and functional status in patients with chronic LBP.

232. Inhibition of neurogenic inflammatory pathways associated with reduction in discogenic back pain

<h3>BACKGROUND CONTEXT</h3> Calcitonin gene-related peptide (CGRP), a neuropeptide found in abundance at the interface between blood vessels and sensory nerve fibers, upregulates pro-inflammatory cytokines including tumor necrosis factor-α, interleukin-6, brain derived neurotrophic factor, and nerve growth factor in spinal spondylotic disease resulting in disc degeneration and sensitization of nociceptive neurons. While the new class of anti-CGRP medications have proven ability to quell neurogenic inflammation in migraines, their off-site efficacy as a therapeutic target for discogenic back/neck pain conditions remains unknown. <h3>PURPOSE</h3> Utilizing a patient population with comorbid degenerative spinal disease and migraines, this study aims to determine if initiation of anti-CGRP biologic treatment for migraines was also associated with improvements in back/neck pain, mobility, and function. <h3>STUDY DESIGN/SETTING</h3> Retrospective case series. <h3>PATIENT SAMPLE</h3> All patients over age 18 with concomitant spinal spondylosis and migraine diagnoses treated with anti-CGRP medications at a single academic institution between 2017-2020 were retrospectively identified. Patients with history of spinal surgery, malignancy, cervicogenic headache, new narcotic prescriptions or inconsistent anti-CGRP use were excluded. <h3>OUTCOME MEASURES</h3> Clinical spine outcomes before and after anti-CGRP medication initiation including pain, mobility and functional status. <h3>METHODS</h3> Patient demographic (age, sex, race, smoking status, BMI) and medical (CCI, depression, anxiety, fibromyalgia) data, follow-up duration, migraine severity and frequency, spine pain, functional status, and mobility before and after anti-CGRP medication initiation were collected. Paired univariate analysis tested for significant changes in spine pain, headache severity, and headache frequency before and after beginning anti-CGRP. Correlation between changes in spine pain score and functional or mobility improvement were assessed with the Spearman's rho coefficient. <h3>RESULTS</h3> A total of 56 patients were included. The mean follow-up time after anti-CGRP initiation was 123 days for spine visits and 129 days for migraine visits. Back/neck pain decreased significantly (p<0.001) from 6.30 to 4.36 after starting anti-CGRP medication for migraine control. As recorded in the spine follow-up notes, 25% of patients experienced functional improvement in ADLs and 17.5% of patients experienced mobility improvement while taking anti-CGRP medication. Change in back/neck pain demonstrated a moderate correlation (ρ= -0.430) with functional improvement but no correlation with mobility improvement (ρ= -0.052). <h3>CONCLUSIONS</h3> Patients receiving anti-CGRP treatment for chronic migraines with comorbid degenerative spine conditions experienced significant off-target back/neck pain reduction. Future interventional studies are necessary to explore the effectiveness of this novel medication class in all patients with discogenic back/neck pain that is recalcitrant to standard nonoperative therapies. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

P49. Proposal of a new standardized method to evaluate spine flexibility using the EOSEdge® low dose radiation imaging for thoracolumbar flexion extension

<h3>BACKGROUND CONTEXT</h3> Thoraco-lumbar vertebral mobility is one of the key parameters that must be analyzed when planning a spinal surgery for spinal deformity. In 1989, Putto et al. published the first radiological procedure to get a 2D X-ray acquisition of patient in a flexion/extension posture of the spine. To date, no similar procedure has been applied to new imaging modality such as the 3D stereoradiography (EOSEdge® imaging) which allow a 3D reconstruction of the spine according to the ALARA concept. <h3>PURPOSE</h3> This study aims to propose a new standardized method to evaluate the vertebral mobility based on the dynamic X-ray using a reproducible method applied to the EOSEdge® imaging technology called. An institutional IRB was obtained for this prospective study. <h3>STUDY DESIGN/SETTING</h3> Observational cohort study. <h3>PATIENT SAMPLE</h3> Fifty patients requested a surgery for spinal deformity. <h3>OUTCOME MEASURES</h3> Intervertebral lordosis and vertebral cobb angle from T11 to S1 were measured individually to assess spine mobility. <h3>METHODS</h3> Candidates for an instrumented spinal surgery had a pre-operative full-spine flexion-extension acquisition according to the predefined protocol using two radiolucent supports that were easy to put in the EOS frame. Extension of the spine was obtained using a height adjustable walker placed behind the patient in the EOS machine allowing stable and safe positioning with limited pain. Patients were then asked to bend backward and keep their position during the acquisition process. To get a full-spine flexion acquisition, patients were seated on a stool and bent forward during the EOS acquisition. Radiographic parameters such as lumbar intervertebral angulation (angulation of each lumbar and thoracic discs) and lumbar lordosis or thoracic kyphosis were analyzed to get a quantitative representation of the spine flexibility. <h3>RESULTS</h3> A total of 50 patients were included in this protocol. Positioning the patients were highly reproducible using external skin landmarks that matched with skeleton anatomy on final images. Comparison of measures between flexion and extension to regular full spine standing imaging showed significant motion and abnormal mobility at some levels not visible in static standing. Limited motion was commonly seen in degenerative spine. <h3>CONCLUSIONS</h3> This study proposes a new standardized method to analyze the spinal flexibility using the EOSEdge® imaging technique. This method can be applied safely to allow detection of abnormal vertebral mobility and therefore a better analysis of spondylolisthesis and degenerative disc disease, which could not be assessed using other conventional static imaging techniques. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Comparative effect of upper thoracic spine mobilization with mobility exercises and upper cervical spine mobilization with stabilization exercises in mechanical neck pain: a randomized clinical trial

Background &amp; Objective: Neck pain is a very prevalent health condition. Physiotherapists use multiple treatment options for treating mechanical neck pain. We evaluated the effects of upper thoracic spine mobilization and mobility exercise and upper cervical spine mobilization and stabilization exercises in treating patients with mechanical neck pain.&#x0D; Methodology: A randomized clinical trial was conducted comprising of 36 patients recruited from different clinics of Faisalabad, both genders, ages from 20-40 y, and randomly divided into two groups. Group A underwent upper thoracic mobilization and mobility exercise while Group B underwent upper cervical mobilization with stabilization exercises for 2 times a week for 4 weeks. Pain scores on Numerical Pain Rating Scale (NPRS) and cervical range of movements (ROM) scores were measured before treatment and then weekly for 4 weeks, while Neck Disability Index (NDI) was assessed at baseline and at the end of 4th week. SPSS version. 22 was used to analyze the data. Independent sample t-test was used for between group compression and P ≤ 0.05 (95%) was considered as significant.&#x0D; Results: There was significant improvement in mean NPRS scores at 1st week, 2nd week, 3rd week and 4th week post-treatment (P &lt; 0.05). There was significant improvement in mean cervical ROM at 2nd week, 3rd week and 4th week post-treatment readings (P &lt; 0.05) and mean NDI score at 4th week (P &lt; 0.05).&#x0D; Conclusion: Both groups were found effective in improving pain, range of motion and neck function, but significant improvement in outcomes was observed in upper cervical mobilization and stabilization exercises group.&#x0D; Abbreviations: NPRS - Numerical Pain Rating Scale; ROM - Range of movements; NDI - Neck Disability Index; MNP - Mechanical neck pain;&#x0D; Key words: Adult; Cervical Vertebrae / physiopathology; Disability Evaluation; Exercise Therapy / methods; Female; Humans; Male; Manipulation, Spinal / methods; Neck / physiopathology; Neck Pain / physiopathology; Neck Pain / rehabilitation; Pain Measurement; Range of Motion, Articular; Thoracic Vertebrae / physiopathology; Treatment Outcome; Young Adult&#x0D; Citation: Tahir R, Sohail MAA, Ain NU, Aine QU, Mannan H, Maqbool A. Comparative effect of upper thoracic spine mobilization with mobility exercises and upper cervical spine mobilization with stabilization exercises in mechanical neck pain: a randomized clinical trial. Anaesth. pain intensive care 2022;26(4):488-495.&#x0D; DOI: 10.35975/apic.v26i4.1952&#x0D; Received: April 11, 2022; Reviewed: June 23, 2022; Accepted: July 14, 2022

Effectiveness of Osteopathic Treatment on the Spinal Column as Measured by the Spinal Mouse®: A Case Series.

IntroductionThis case series aims to compare changes in spinal column mobility using the Spinal Mouse® (Idiag, Volketswil, Switzerland), a device providing a spatial survey of a single vertebra's position. The measurements have been made before and after an osteopathic treatment with different spinal column positions on healthy subjects. We presumed that osteopathic treatment is able to improve spinal column mobility.MethodsThe measurement was carried out with the naked spinal column in the following positions: standing, static bending, dynamic bending, and conducting the static Matthiass test, which consists of maintaining the standing position with outstretched arms, with a 1 kg weight. We evaluated the vertebral tilt degrees and changes in height (expressed in mm) in the mentioned positions before and after the osteopathic treatment.ResultsWe observed improvements in spinal column tilt (expressed in degrees) and in vertebral metameres length (expressed in mm) in a standing position (T<0.04 and T<0.04). We also noted a global increase in tilt (expressed in degrees) during the static bending position (T<0.05) and in the thoracic tract during the Matthiass test (T<0.02).ConclusionsThe present study highlighted that osteopathic treatment was able to increase vertebral mobility, concerning tilt (expressed in degrees) and length (expressed in mm), evaluated in different positions.

Which Metrological Index, the BASMI or EDASMI, is Best Correlated with Disease-Related Parameters in Spondylarthritis Patients?

This study aimed at comparing the Edmonton Ankylosing Spondylitis Metrology Index (EDASMI) and Bath Ankylosing Spondylitis Metrology Index (BASMI) to determine which of the two is best correlated with disease-related parameters in axial spondyloarthritis (axSpA) patients. A cross-sectional study was carried out involving 86 patients with radiographic axSpA. Sociodemographic data, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Ankylosing Spondylitis Disease Activity Score (ASDAS), the Bath Ankylosing Spondylitis Functional Index (BASFI), and the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire were applied. Spinal mobility was assessed by two indices: the BASMI and the EDASMI. Structural damage of the spine was also evaluated by two indices: the Bath Ankylosing Spondylitis Radiology Index (BASRI) and the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Eighty-six patients with an average age of 43.21 ± 11.43 years (20-79) were included. Impaired spinal mobility, which corresponds to higher BASMI scores, was correlated with prolonged disease duration (p < 0.01, r = 0.310), higher ASDAS-CRP (p < 0.001, r = 0.386), severe functional disability on the BASFI (p < 0.01, r = 0.505) and poorer quality of life according to the ASQoL (p < 0.01, r = 0.369). However, the EDASMI score did not correlate with any disease parameter. The BASMI was correlated with the total BASRI (p < 0.01, r = 0.634) and mSASSS (p < 0.01, r = 0.388). Unlike the BASMI, the EDASMI was neither correlated with the BASRI (p = 0.520, r = 0.245) nor the mSASSS (p = 0.252, r = -0.120). Our results indicate that among the studied metrological indices, the BASMI is more contributory since it is correlated with clinical disease parameters and structural damage, unlike the EDASMI.

Effects of Muscle Energy Technique and Joint Manipulation on Pulmonary Functions, Mobility, Disease Exacerbations, and Health-Related Quality of Life in Chronic Obstructive Pulmonary Disease Patients: A Quasiexperimental Study.

Chronic obstructive pulmonary disease (COPD) is primarily a disease of the lungs; however, extrapulmonary comorbidities like rib cage stiffness, decreased thoracic spine mobility, postural changes, and skeletal muscle dysfunctions also coexist. Muscle energy technique (MET) and joint manipulation (JM) may help alleviate these musculoskeletal problems. This study was aimed at evaluating the effectiveness of MET and JM on pulmonary functions, dyspnea, chest wall mobility, disease exacerbations, and health-related quality of life in COPD patients. A total of 16 patients (7 women and 9 men) suffering from COPD between the ages of 35 and 65 years participated in the study. Pretest-posttest quasiexperimental design was used. MET was applied to the sternocleidomastoid, anterior scalene, pectoralis major muscles, and at the C4-C6 level of the cervical spine. Maitland JM was performed in the thoracic region at the intervertebral, costovertebral, and costotransverse joints. The treatment intervention lasted for 3 weeks. FEV1/FVC, maximum inspiratory pressure (MIP), SpO2, modified Borg dyspnea scale (MBDS), COPD assessment test (CAT), mMRC dyspnea scale, BODE index, right and left hemidiaphragm excursion, and chest wall expansion at T4 and T10 levels were the outcome measures. Significant improvement (p < 0.05) was observed in FEV1/FVC, MIP, SpO2, MBDS, CAT, mMRC dyspnea scale, BODE index, and chest expansion at T4 and T10 levels. Only for the hemidiaphragm excursion, no significant (p > 0.05) improvement was observed. Combined application of MET to accessory respiratory muscles and cervical spine and JM to thoracic spine improved pulmonary functions, chest wall mobility, and health-related quality of life and reduced dyspnea and disease exacerbations in patients with mild to moderate COPD.

Association of fear assessment in inflammatory rheumatic diseases (FAIR) questionnaire with ankylosing spondylitis quality of life and disease activity in patients with ankylosing spondylitis

Background/Aim: Fear against disease course, treatment, and limitations in family, work, and social life are commonly seen but mostly overlooked by physicians of patients with chronic inflammatory rheumatic diseases. Ankylosing spondylitis (AS) is a chronic inflammatory disease in young adults characterized by limitations in spinal mobility. The Fear Assessment (FAIR) Questionnaire was designed especially for patients with rheumatoid arthritis and spondyloarthritis to assess the level of fear from the patient’s perspective. Here we evaluate the FAIR score in AS patients and its association with disease activity, AS quality of life (ASQoL), depression, anxiety, and fatigue levels.&#x0D; Methods: This cross-sectional study included 79 patients with AS, and disease activity was assessed by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), AS-Disease Activity Score-C reactive protein, and functional status was assessed by Bath Ankylosing Spondylitis Functional Index (BASFI). Patient global assessment of disease and pain were scored on 0–10 cm visual analog scores. All patients completed FAIR and ASQoL questionnaires. The depression and anxiety were evaluated by Hospital Anxiety and Depression Scale (HADS), and fatigue was assessed by Fatigue Severity Scale (FSS).&#x0D; Results: The mean age of AS patients (62% male) was 41.7 (11.3) years. Most of the patients were on biological disease-modifying anti-rheumatic drugs (bDMARDs). The patients’ median BASDAI, ASDAS-CRP, and BASFI were 5.4 (range, 3.8–7.4), 3.83 (1.4), and 4.0 (range, 2.3–6.2), respectively. The overall FAIR, ASQoL, FSS, HADS-depression, and HADS-anxiety scores were 75 (range, 52–91), 9.6 (5.2), 5.4 (range, 4.1–7), 7.7 (4.4) and 9.6 (5.2), respectively. There were statistically significant correlations between disease activity indices and FAIR, ASQoL, FSS, and HADS scores. The FAIR scores significantly correlated with ASQoL, FSS, and HADS scores. The patients with active disease (BASDAI ≥ 4) had significantly higher levels of FAIR, ASQoL, FSS, and HADS. The best cut-off value for the FAIR score of AS patients with moderate to severe disease activity was 50 (AUC: 0.734, 95% CI [0.599–0.870], P = 0.002), with a sensitivity of 89.8%, specificity of 55%, positive likelihood ratio of 1.99, and Youden index of 0.45.&#x0D; Conclusion: This study shows that AS patients face a high level of fear which is associated with higher disease activity, higher risk of mood disorders, and lower quality of life. Physicians should not only focus on the physical improvement of the patient but also handle the fear of patients against their diseases and their treatment. This holistic approach will improve the dialogue between the physician and the patient, which will result in increased compliance with treatment and will raise the quality of care.

Comparison between upper thoracic spine mobilization and the Ergon technique in the treatment of mechanical neck pain

Upper thoracic spine mobilization and the Ergon technique are used to treat mechanical neck pain in order to speed recovery, promote tissue healing and improve range of motion. There have been a few studies discussing the Ergon IASTM and upper thoracic spine mobilization in patients with neck pain, but none compared the aforementioned techniques in the treatment of mechanical neck pain. This clinical trial was conducted on a sample of thirty participants (16 females and 14 males) with mechanical neck pain who were randomly divided into two groups: Upper Thoracic Spine Mobilization (n=15) and Ergon Technique (n=15). Twelve sessions were delivered to all participants over a four-week period, three days per week. Before and after treatment, pain severity was measured by Numeric Pain Rating Scale (NPRS), cervical spine's active range of motion was measured by using a Cervical Range of Motion (CROM) device, and cervical spine's disability index was measured by Neck Disability Index (NDI). The statistical analysis was carried out using the Statistical Package for Social Sciences (SPSS) version 25. Both groups showed improvement in neck pain, reduced functional disability and increased cervical range of motion after treatment. The upper thoracic spine mobilization group had significantly better results in terms of cervical left lateral flexion and left rotation ranges of motion, while the Ergon Technique group had significantly better results in terms of improvement of neck pain and reduction in functional disability. In conclusion, the upper thoracic spine mobilization was effective at increasing the range of motion of the cervical region, while the Ergon technique was effective at relieving pain and dysfunction in the cervical spine in patients with mechanical neck pain. Upper thoracic spine mobilization and the Ergon technique are used to treat mechanical neck pain in order to speed recovery, promote tissue healing and improve range of motion. There have been a few studies discussing the Ergon IASTM and upper thoracic spine mobilization in patients with neck pain, but none compared the aforementioned techniques in the treatment of mechanical neck pain. This clinical trial was conducted on a sample of thirty participants (16 females and 14 males) with mechanical neck pain who were randomly divided into two groups: Upper Thoracic Spine Mobilization (n=15) and Ergon Technique (n=15). Twelve sessions were delivered to all participants over a four-week period, three days per week. Before and after treatment, pain severity was measured by Numeric Pain Rating Scale (NPRS), cervical spine's active range of motion was measured by using a Cervical Range of Motion (CROM) device, and cervical spine's disability index was measured by Neck Disability Index (NDI). The statistical analysis was carried out using the Statistical Package for Social Sciences (SPSS) version 25. Both groups showed improvement in neck pain, reduced functional disability and increased cervical range of motion after treatment. The upper thoracic spine mobilization group had significantly better results in terms of cervical left lateral flexion and left rotation ranges of motion, while the Ergon Technique group had significantly better results in terms of improvement of neck pain and reduction in functional disability. In conclusion, the upper thoracic spine mobilization was effective at increasing the range of motion of the cervical region, while the Ergon technique was effective at relieving pain and dysfunction in the cervical spine in patients with mechanical neck pain.

Effects of Transcutaneous Electrical Nerve Stimulation in Patients with Chronic Non-Specific Low Back Pain

The management of low back pain (LBP) encompasses a diverse range of possible interventions including drug therapy, surgery, exercise, patient education, physiotherapy, cognitive-behavioral therapy and various other non-pharmacological therapies. Acute and chronic LBP warrant separate consideration as they may respond differently to the same interventions. Transcutaneous electrical nerve stimulation (TENS) is widely used as a therapeutic adjunct in the management of low back pain. It is relatively safe, non-invasive and easy to use modality that makes it an attractive treatment option. For more than four decades, TENS has been applied in the treatment of acute and chronic pain syndromes. Hence there is still uncertainty about the most effective therapeutic approach in chronic non-specific low back pain. Methods: This randomized controlled clinical trial was conducted in the department of Physical Medicine and Rehabilitation, Chatto gram from 13/01/2019 to 13/06//2019. The aim of the study was to evaluate the effects of Transcutaneous Electrical Nerve Stimulation on Chronic Non-specific Low Back Pain Patients. 120 patients with chronic low back pain were treated according to inclusion &amp; exclusion criteria. Patients were equally distributed in three groups. Group-A patients (n=40) treated with NSAID+ADL, and Group-B patients (n=40) treated with NSAID+ADL+TENS and Group-C patients (n=40) treated with NSAID+ ADL+ Back extension exercise. Written informed consent was obtained from all patients. Data were calculated and analyzed by computer based software SPSS (Statistical Package for social Science) windows 16.0 version. Main Outcome Measure (S): Age, Sex, Occupational status, Socio-economic status, Subjective pain intensity score, Visual Analogue Scale, Tenderness index, Disability due to pain, Spinal mobility index, Oswestry disability Index. Results: The mean age was found 41.82±11.95 years in group A and 42.7±12.52 years in group B and 40.52±13.40 in group C.........

Definition and classification for adverse events following spinal and peripheral joint manipulation and mobilization: A scoping review.

IntroductionSpinal and peripheral joint manipulation and mobilization are interventions used by many healthcare providers to manage musculoskeletal conditions. Although there are many reports of adverse events (or undesirable outcomes) following such interventions, there is no common definition for an adverse event or clarity on any severity classification. This impedes advances of patient safety initiatives and practice. This scoping review mapped the evidence of adverse event definitions and classification systems following spinal and peripheral joint manipulation and mobilization for musculoskeletal conditions in adults.MethodsAn electronic search of the following databases was performed from inception to February 2021: MEDLINE, EMBASE, CINAHL, Scopus, AMED, ICL, PEDro, Cochrane Library, Open Grey and Open Theses and Dissertations. Studies including adults (18 to 65 years old) with a musculoskeletal condition receiving spinal or peripheral joint manipulation or mobilization and providing an adverse event definition and/or classification were included. All study designs of peer-reviewed publications were considered. Data from included studies were charted using a standardized data extraction form and synthesised using narrative analysis.ResultsFrom 8248 identified studies, 98 were included in the final synthesis. A direct definition for an adverse event and/or classification system was provided in 69 studies, while 29 provided an indirect definition and/or classification system. The most common descriptors to define an adverse event were causality, symptom severity, onset and duration. Twenty-three studies that provided a classification system described only the end anchors (e.g., mild/minor and/or serious) of the classification while 26 described multiple categories (e.g., moderate, severe).ConclusionA vast array of terms, definition and classification systems were identified. There is no one common definition or classification for adverse events following spinal and peripheral joint manipulation and mobilization. Findings support the urgent need for consensus on the terms, definition and classification system for adverse events related to these interventions.

Effects of Transcutaneous Electrical Nerve Stimulation in Patients with Chronic Non-specific Low Back Pain as an Add-on Therapy

Background : Transcutaneous Electrical Nerve Stimulation (TENS) is often used to treat Low-Back Pain (LBP). However, its effectiveness is controversial in non-specific chronic LBP (CLBP). The study aimed to determine TENS’ efficacy in treating non-specific CLBP when added to Non-Steroidal Anti- Inflammatory Drugs (NSAIDs) and Activities of Daily Living (ADL). Materials and methods: This randomized controlled clinical trial was conducted in the Department of Physical Medicine and Rehabilitation of Chittagong Medical College Hospital, Chattogram, over six months from January 2019 to June 2019. Ninety patients suffering from LBP for more than six weeks were enrolled and randomized into Group A, and Group B. Patients in both groups were treated with NSAID+ADL. TENS was added to the patients of Group B. Subjective pain intensity score, Visual Analogue Scale (VAS) Tenderness index, Disability due to pain, Spinal mobility index and Oswestry Disability Index was the outcome parameters assessed at baseline and after eight weeks of intervention. Results: Ten patients were lost to follow-up (Five from each group) giving an effective sample of 80 (40 in each group). Both the groups were similar at enrollment in terms of the demographic, clinical and laboratory parameters. In Group A and B, the VAS score at baseline was 7.06±0.81 and 7.11±0.83, respectively. At eight weeks, the VAS score was 6.55±0.77 and 6.11±0.75, respectively, in Group A and B. Reduction of VAS scores was significant in both groups without any statistical differences. Similarly, Disability due to pain and Oswestry Disability Index scores reduced significantly from baseline to eight weeks after treatment in both groups, without statistically significant differences. Conclusion: The study ascertained no additional benefit of TENS in patients of non specific CLBP when added to NSAID and ADL. IAHS Medical Journal Vol 5(1), June 2022; 82-86

Combination of Two Manipulative Techniques for the Treatment of Cervicogenic Dizziness: A Randomized Controlled Trial.

Cervicogenic dizziness is clinically associated with upper cervical spine dysfunctions. It seems that manual therapy decreases the intensity of dizziness in these subjects, but what happens to pain measured by pressure pain threshold (PPT) has not been studied. Purpose: analyze the short-term effects of combination two manipulation techniques protocol in worst dizziness intensity (wVAS), dizziness and cervical disability, upper cervical spine mobility and mechanosensivity of cervical tissue. Methods: Assessor-blinded randomized controlled trial was developed. A total of 40 patients with cervicogenic dizziness were randomly divided into two groups. The experimental group received three treatments consisting of a functional massage and a manipulation technique, and compared with a control group. The wVAS, dizziness handicap inventory (DHI), neck disability index (NDI), UCS mobility, and PPTs were measured. Measurements were made at the baseline, first follow-up 48 h after intervention and second follow-up 1 month after the intervention. Results: at second follow-up wVAS (p < 0.001), NDI (p < 0.001), DHI (p < 0.001), and upper right trapezius (p < 0.022) and right suboccipital (p < 0.043) PPTs showed a difference between groups in favor of the experimental group. Conclusions: apparently, the proposed intervention protocol decreases the intensity of dizziness and the mechanosensitivity of the cervical tissue and improves the feeling of disability due to neck pain and dizziness.

The effect of upper limb lymphedema in posture of patients after breast cancer surgery.

Upper limb lymphedema is one of the complications following breast cancer-related surgery. It is a fact that there are alterations in posture of the trunk following surgery, however, there is not much data on whether upper limb lymphedema has any effect on body posture. The main purpose of the study was to investigate the effect of upper limb lymphedema in the trunk posture and spine mobility of patients following breast cancer surgery. Twenty-seven women with lymphedema and 29 women without lymphedema with mastectomy or breast-conserving surgery participated in the study. Posture was evaluated by the New York Posture Rating Chart and spinal stability and thoracic mobility were evaluated by the Spinal Mouse device. Posture and spine posture scores were significantly higher in the without lymphedema group (p= 0.004; 0.041; respectively). There was a significant difference between the groups in terms of lateral (p< 0.001) and posterior (p< 0.001) view of shoulders, spine (p= 0.027), upper (p< 0.001) and lower back (p= 0.009), and trunk postures (p= 0.001). Body posture and spine are more affected due to upper limb lymphedema following breast cancer surgery. Alterations of posture mainly occur on shoulders, spine, upper and lower back, and trunk, but not on head and neck postures.

Modular dual-mobility articulations in patients with adverse spinopelvic mobility

Aims Adverse spinal motion or balance (spine mobility) and adverse pelvic mobility, in combination, are often referred to as adverse spinopelvic mobility (SPM). A stiff lumbar spine, large posterior standing pelvic tilt, and severe sagittal spinal deformity have been identified as risk factors for increased hip instability. Adverse SPM can create functional malposition of the acetabular components and hence is an instability risk. Adverse pelvic mobility is often, but not always, associated with abnormal spinal motion parameters. Dislocation rates for dual-mobility articulations (DMAs) have been reported to be between 0% and 1.1%. The aim of this study was to determine the early survivorship from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) of patients with adverse SPM who received a DMA. Methods A multicentre study was performed using data from 227 patients undergoing primary total hip arthroplasty (THA), enrolled consecutively. All the patients who had one or more adverse spine or pelvic mobility parameter had a DMA inserted at the time of their surgery. The mean age was 76 years (22 to 93) and 63% were female (n = 145). At a mean of 14 months (5 to 31) postoperatively, the AOANJRR was analyzed for follow-up information. Reasons for revision and types of revision were identified. Results The AOANJRR reported two revisions: one due to infection, and the second due to femoral component loosening. No revisions for dislocation were reported. One patient died with the prosthesis in situ. Kaplan-Meier survival rate was 99.1% (95% confidence interval 98.3 to 100) at 14 months (number at risk 104). Conclusion In our cohort of patients undergoing primary THA with one or more factor associated with adverse SPM, DM bearings conferred stability at two years’ follow-up. Cite this article: Bone Joint J 2022;104-B(7):820–825.

Postoperative Sagittal Balance Has Only a Limited Role in the Development of Adjacent Segment Disease After Lumbar Spine Fusion for Degenerative Lumbar Spine Disorders: A Subanalysis of the 10-year Follow-up Study.

Study Design.Retrospective additional analysis of a prospective follow-up study.Objectives.We aimed to find out whether poor postoperative sagittal alignment increases revisions for adjacent segment disease (ASD) after lumbar spine fusion (LSF) performed for degenerative lumbar spine disease.Summary of Background Data.Revisions for ASD accumulate over time after LSF for degenerative lumbar spine disease. The etiology of ASD is considered multifactorial. Yet, the role of postoperative sagittal balance in this process remains controversial.Materials and Methods.A total of 215 consecutive patients who had undergone an elective LSF surgery for spinal stenosis with (80%) or without (20%) spondylolisthesis were analyzed. Spinal reoperations were collected from the hospital records. Preoperative and postoperative sagittal alignment were evaluated from standing radiographs. The risk of revisions for ASD was evaluated by Cox proportional hazards regression models.Results.We did not find the poor postoperative balance [pelvic incidence−lumbar lordosis (LL) >9°] to significantly increase the risk of revisions for ASD: crude hazard ratio (HR)=1.5 [95% confidence interval (CI): 0.8–2.7], adjusted (by age, sex, pelvic incidence, fusion length, and the level of the caudal end of fusion): HR=1.7 (95% CI: 0.9–3.3). We found higher LL outside the fusion segment (LL−segmental lordosis) to decrease the risk of revisions for ASD: HR=0.9 (95% CI: 0.9–1.0).Conclusion.Poor sagittal balance has only a limited role as a risk factor for the revisions for ASD among patients with degenerative spinal disease. However, the risk for ASD might be the greatest among patients with reduced spinal mobility.

Effects Of Modified ELDOA Technique in Patients with Cervical Radiculopathy

ELDOA is a revolutionary technique for improvement of health and longevity of the spine which is introduced by French osteopath; Guy Voyer. The primary goal of ELDOA is to apply focused internal tension and load to decrease pressure on the discs of spine, increase blood flow and to reduce pain at cervical spine. There is little high-quality evidence on best no operative therapy for cervical radiculopathy. Objective: To determine the effects of Modified ELDOA technique in patients with cervical radiculopathy in terms of pain, nerve tension and disability. Methods: Thirty patients were randomly assigned either to a group that performed modified ELDOA along with conventional treatment aimed at decreasing the effects of pain, nerve tension and disability or to a group that performed ELDOA and received conventional treatment having the same goal as the former. Randomized controlled trial was selected as the design of study. Treatment protocol of control group included hot pack, TENS, PIR(MET) 4 reps with 6 sec hold, Maitland oscillations (20 reps in 3 sets), ELDOA at cervical spine, Neurodynamic stretching of involved nerve. Treatment protocol of experimental group included hot pack, TENS, PIR(MET)4 reps with 6 seconds hold, Maitland oscillations (20 reps in 3 sets), modified ELDOA at cervical spine, Neurodynamic stretching of involved nerve. Each patient received 8 sessions on alternate days covered in a total span of 16 days. Assessments were done at 1st 8thsession.The tools used were NDI, NPRS and ROM through goniometer. IBMSPSS-21 was used to analyze data. Results: The results demonstrated that treatment protocols of both the control and experimental groups have significant effects on reducing pain, tension and disability and improving mobility of cervical spine. Whereas, for difference in effectiveness of modified ELDOA and ELDOA, the overall p-values came out to be &gt;0.05 while comparing the end values of both groups, showing that there is a non-significant difference in the effects of ELDOA and modified ELDOA. Conclusion: Modified ELDOA works effectively in posture correction hence improving the functional status of patient. Modified ELDOA and ELDOA postures help in treatment of cervical radiculopathy. The effectiveness of ELDOA and modified ELDOA has a non-significant difference.

Even mild intervertebral disc degeneration reduces the flexibility of the thoracic spine: an experimental study on 95 human specimens

BACKGROUND CONTEXTIntervertebral disc degeneration represents one of multiple potential trigger factors for reduced passive spinal mobility and back pain. The effects of age-related degenerative intervertebral disc changes on spinal flexibility were however mainly investigated for the lumbar spine in the past, while intervertebral disc degeneration is also highly prevalent in the thoracic spine. PURPOSETo evaluate the effect of the degeneration grade on the range of motion and neutral zone of the thoracic spine. STUDY DESIGNExperimental study including combined radiological grading of intervertebral disc degeneration and biomechanical testing of 95 human thoracic functional spinal units (min. n=4 per level from T1–T2 to T11–T12) from 33 donors (15 female / 18 male, mean age 56 years, age range 37–80 years). METHODSDegeneration grades of the intervertebral discs were assessed using the validated x-ray grading scheme of Liebsch et al. (0=no, 1=mild, 2=moderate, 3=severe degeneration). Motion segments were loaded with pure moments in flexion/extension, lateral bending, and axial rotation to determine range of motion and neutral zone at 5 Nm. RESULTSAll tested specimens exhibited degeneration grades between zero and two. Range of motion significantly decreased for grades one and two compared with grade zero in any motion direction (p<.05), showing the strongest decrease in extension comparing grade two with grade zero (-42%), while no significant differences were detected between grades one and two. Similar trends were found for the neutral zone with the strongest decrease in extension also comparing grade two with grade zero (-47%). Donor age did not significantly affect the range of motion, whereas the range of motion was significantly reduced in specimens from male donors due to the significantly higher degeneration grade in this study. CONCLUSIONSEven mild intervertebral disc degeneration reduces the range of motion and neutral zone of the thoracic spine in any motion plane, whereas progressing degeneration does not further affect its flexibility. This is in contrast to the lumbar spine, where a more gradual decrease of flexibility was found in prior studies, which might be explained by differences between thoracic and lumbar intervertebral disc morphologies. CLINICAL SIGNIFICANCEThoracic intervertebral disc degeneration should be considered as one of multiple potential causal factors in patients showing reduced passive mobility and middle back pain.

Comparison Of the Effectiveness of Maitland Manipulation of Thoracic Spine Versus Grade I And II Maitland Mobilization of Cervical Spine on Pain Intensity and Functional Status in Patients of Cervical Radiculopathy

Cervical radiculopathy (CR) is a most reported pathological problem mainly due to herniated disc material causing nerve compression or the formation of osteophytes. This impingement specifically causes cervical pain radiating to arm, numbness, and sensory deficit. It also affects the motor function of the neck and upper extremities. Objectives: To evaluate the comparative effectiveness of Maitland manipulation of thoracic spine versus grade I and II Maitland mobilization of cervical spine on Pain, intensity, and functional status in patients of cervical radiculopathy. Methods: Total 32 patients suffering from cervical radiculopathy were randomly assigned to receive Maitland manipulation on thoracic spine along with Conventional Physiotherapy (intermittent cervical traction, strengthening exercises) in Group A(n=16) and Maitland mobilization on cervical spines along with Conventional Physiotherapy in Group B (n=16). Total treatment sessions given to each group was 9 (3 sessions per week). To measure outcome numeric pain rating scale (NPRS) and neck disability index (NDI) questionnaire was used. Data collection was done at the beginning and post-treatment. Results: The study revealed that the mean age of patients was 47.59 with a range minimum of 27 years to a maximum of 59 years. Comparison of post-treatment of both groups showed mean NPRS score in group A (Maitland thoracic spine manipulation) was 4.56± 1.031 and group B (Maitland cervical spine mobilization) was 6.12± 0.50, while post-treatment NDI score group A was 22.44± 10.09 and group B was 36.88± 8.437 with p=0.000 that was p&lt;0.05. Conclusion: The study concluded that both Maitland thoracic spine manipulation and Maitland cervical spine mobilization techniques have similar effects in reducing cervical radiculopathy and increasing active range of motion. However, Maitland thoracic spine manipulation showed better results in neck pain reduction and improved functional status on the comparison.