The consequence of head-loading on the neuro-musculoskeletal health of the ILembe District youth of KwaZulu-Natal

Background: Head-loading, as a mode of transporting food, water and firewood, is a longstanding tradition assigned to female South African youth and has been associated with adverse health consequences. Objectives: This study determined the impact of head-loading on the neuromusculoskeletal health and proprioception of female South African youth. Method: This study comprised a counterbalanced, within-subject, single-factor experimental design which compared the changes that occurred when the same independent variable (head-loading) within two homogenous groups was measured in terms of the dependent variables (outcomes: neuromusculoskeletal pain and proprioception) at two time periods, before and after the introduction of the independent variable. A cohort of South African female youth (n = 100), aged 9­17 years, voluntarily partook in the study. The participants were randomly distributed into an experimental (n = 50) and a control (n = 50) group. The experimental group stood in a head-loaded state with their respective habitual head-load mass. Their proprioception measurements were compared during their unloaded versus loaded states, with the proprioceptive measurements including the total proprioception index, the anterior­posterior (front­back) index and the medial­lateral (side-to-side) index. Participants furthermore completed a head-loading health-related questionnaire. Results: Participants had a mean age of 12.3 ± 2.5 years, body mass of 44.4 ± 13.7 kg, stature of 145 ± 10 cm and a head-load mass of 8.0 ± 2.5 kg. Participants had poorer medial­lateral proprioception during head-loading as compared to their unloaded state (1.4 ± 0.8 as compared to 1.6 ± 0.9) (p < 0.05). Most youth (96%) experienced neuromusculoskeletal pain in their cervical vertebrae (40.9%), shoulders (27.3%), lumbar vertebrae (10.7%), arms (8.3%), legs (8.3%), knees (1.9%), fingers (1.5%), toes (0.5%) and thoracic vertebrae (0.5%) (χ2: p < 0.05). Conclusion: Head-loading adversely affects the medial­lateral proprioception and neuromusculoskeletal health of participants.

Effect of combining epidural with general anesthesia on recovery after spine surgery: randomized controlled study

Background: Fast track techniques have been applied to reduce surgical stress response and to provide effective perioperative analgesia, thereby improving patient''''''''s recovery and reducing postoperative morbidity. The present study was undertaken to assess the effect of using combined general/epidural anesthesia (CGEA) on early recovery after lumbar spine surgeries. Subjects and Methods: The current prospective randomized clinical study had included a total of 40 patients who underwent elective one or two level laminectomy/discectomy. Patients were randomized and divided into two groups; general anesthesia (GA) group (group I) and combined general/epidural anesthesia group (CGEA) (group II). Patient characteristics, anesthesia time, surgical time, heart rate, mean arterial pressure (MAP), anesthetic / analgesic requirements, the occurrence of intraoperative bradycardia and/or hypotension, time to extubation, time to post anesthesia care unit (PACU) discharge and duration of PACU stay were recorded and considered for analysis. Results: It was observed that CGEA was significantly associated with reduction of intraoperative anesthetics / analgesic requirements, shorter time to extubation, time for PACU discharge and duration of PACU stay but on the expense of higher incidence of intraoperative hypotension. Conclusion: This study proved that CGEA seems to be an effective fast track anesthetic protocol in patients undergoing elective lumbar spine surgeries

Revision surgery in lumbar degenerative disease

Introduction: Lumbar degenerative disease is a common health problem all over the world and the need for revision surgery is still high with variable results. The aim of the work: Is to evaluate the clinical and radiologic outcome in cases of redo surgery for lumbar degenerative pathology and to specify which pathology is responding well to revision surgery.Patients and methods: Forty eight patients were operated upon for revision of previous failed back surgery in Zagazig University Hospitals from August 2014 to April 2017. Selection of patients for revision surgery depends on confirmed radiological and clinical compression or instability. All patients were operated and followed for at least 6 months after surgery. VAS score was used as a tool for evaluation of back and leg pain.Results: There were 48 patients; with a mean age of 46.7 years (range 22-78).There were 29 males and 19 females. The dominant symptoms were unilateral sciatica in 30, bilateral in 11, low back pain in 23 patients.Neurogenic claudication was present in 4 cases. Type of surgery was redo discectomy in 31 cases, revision decompression for spinal canal stenosis in 4 cases, and posterior lumbar interbody fusion in 13 cases, with success rate of 96.8%, 75% and 84.6% respectively regarding improvement after surgery.Conclusion: Revision surgery of lumbar degenerative diseases gives excellent results provided that the patients are properly selected

Fréquence hospitalière, facteurs associés et aspects radiologiques des discopathies dégénératives lombaires au CNHU-HKM de Cotonou

Introduction : Le rachis lombaire du fait de sa mobilité importante est le plus souvent touché par des discopathies dégénératives. L'imagerie permet de caractériser les types de lésions. Les objectifs de ce travail ont été de déterminer la fréquence hospitalière et les facteurs associés et de décrire les aspects radiographiques et scanographiques des discopathies dégénératives lombaires chez les patients suivis en consultation de rhumatologie au CNHU-HKM de Cotonou. Patients et méthodesEtude transversale descriptive et analytique sur 6 mois portant sur les patients suivis dans le service de rhumatologie pour des symptômes rhumatologiques et ayant bénéficié d'un examen d'imagerie médicale. Résultats : La fréquence hospitalière des discopathies dégénératives lombaires étaient de 36,76%. L'âge moyen des sujets atteints était de 56,3 +/- 12,2 [27-85] ans. La sex ratio était de 1/3. La discarthrose était prédominante (32,12%) devant la discopathie bombante et la hernie discale avec respectivement une fréquence hospitalière de 17,88% et 14, 23%. La radiographie a contribué au diagnostic dans 48% des cas tandis que le scanner avait été réalisé dans 52% des cas. L'âge, la vie en couple et les antécédents de lombalgie étaient significativement associés à la survenue de discopathie dégénérative (p= 0,00, 0,03 et 0,000 respectivement). Conclusion : Les discopathies dégénératives sont fréquentes en milieu hospitalier au CNHU-HKM de Cotonou. L'âge constitue le facteur de risque identifié. Le scanner, un outil diagnostic améliorant la performance du diagnostic mais son accessibilité était limitée par son coût élevé dans notre pays

Radiographic lumbar spondylosis: Gender and age group prevalence in Nigeria

Background: Lumbar spondylosis (LS) increases with, and is perhaps an inevitable concomitant of age, and is a major cause of low back pain and disability in the elderly. The prevalence in Nigeria is poorly documented, and its knowledge will assist in patient management. Objective: The aim is to study the gender and age group prevalence of LS in Nigeria. Materials and Methods: This is a retrospective review of 368 anteroposterior and lateral lumbosacral spine spondylotic radiographs of patients of both genders. Data analysis was performed with IBM SPSS Statistics 20.0 (New York, USA). The value of P < 0.05 was considered statistically significant. Results: The age range was 17­90 years, mean (standard deviation) was 51.96 (13.49) years. The majority (201 [55%]) were aged 45­64 years. The males (217 [59%]) were aged 17­90 years, and the mean (standard deviation) was 52.28 (14.49) years, whereas the females (151 [41%]) were aged 17­80 years, and the mean (standard deviation) was 51.51 (11.95) years. The mean ages showed no significant gender difference (P = 0.429). Male: female ratio was 1.4:1. LS prevalence increased with age, peaked at 45­54 years in females, 55­64 years in males, and steadily declined to zero, in females after 80 years, and in males after 90 years. Conclusion: LS prevalence started as early as 17 years of life, increased with age, peaked at 45­54 years in females, 55­64 years in males, and steadily declined to zero, in females after 80 years, and in males after 90 years. Sex ratio showed slight male preponderance

Suprnumerary Lumbar Vertebrae in Human Skeletons at the Galloway Osteological Collection of Makerere University; Kampala

Objective: To find out the number of other skeletons in the Galloway collection that have a variation of six lumbar vertabrae. Design: A descriptive cross-sectional study. Setting: Department of Anatomy; Faculty of Medicine; Makerere University; Kampala. Materials: Five hundred and ninety one skeletons in the Galloway Oesteological Collection housed in the basement of the Department of Anatomy; Faculty of Medicine; Makerere University. Interventions: The skeletons were examined. Those found to have six lumbar vertebrae were scrutinised further. A recount was done of the cervical and thoracic vertbrae in order to ascertain the identity and number of the lumber vertebrae. Some of the skeletons were x-rayed and photographed to illustrate the finding and the manner in which the transverse processes of the sixth vertebrum articulated with the alar of the sacrum. Results: Out of the 591 skeletons examined; twentywere found to have a sixth lumbar vertebrum. In sevenof these; the transverse processes of the sixth lumbar vertebrum were found to be bilaterally articulated with the alar of the sacrum and in another five.only the left was. In the remaining eight; the transverse processes did not articulate with the alar of the sacrum at all. Right unilateral articulation between the transverse process and the alar of the sacrum was not observed in any of the twenty skeletons that had six lumbar vertebrae. Conclusion: In the Galloway osteological collection there is a small number of skeletons in which the number of lumbar vertebrae is six instead of 5 as is normally the case. In most of them the transverse processes of the sixth lumbar vertebrum articulate with the alar of the sacrum through a synovial joint (bilateral or unilateral). The above observations have raised several questions in the mind of the author regarding the mechanism of causation of the variation and its clinical and functional implications