The squat exercise recruits core muscles as much as localized exercises / O exercício de agachamento recruta músculos do tronco tanto quanto exercícios localizados

Abstract Introduction In the context of resistance training, which encompasses both strengthening and rehabilitation, the incorporation of global range exercises demands intense activation of the trunk muscle groups, which play a primary role in body stabilization. The squat, notorious for its complexity and effectiveness in activating stabilizers during execution, raises a central question: whether this exercise recruits the muscles more significantly compared to localized exercises, such as push-ups and trunk exten-sions. Objective To identify the degree of activation of the trunk muscles during squats and compare it with localized exercises for the trunk muscles: lumbar and abdominal. Methods Using surface electromyography, the activation of the iliocostalis, multifidus, internal oblique, external oblique and rectus abdominis muscles was evaluated. The sample included 16 physically active volunteers of both sexes. A repeated measures t-test (α < 0.05) was used as an analysis method. Results The iliocostalis, multifidus and internal oblique muscles showed similar levels of activation both in the squat and in their respective isolated exercises, while the rectus abdominis and external oblique muscles showed greater activity during trunk flexion. Conclusion It is possible to infer that squats are an effective exercise for training the iliocostalis, multifidus and internal oblique muscles, while localized exercises are more suitable for strengthening the external oblique and rectus abdominis muscles. Such conclusion can contribute to optimizing the planning of exercise sessions by replacing isolated trunk exercises with squats.

Resumo Introdução No contexto do treinamento resistido, que engloba tanto o fortalecimento quanto a reabilitação, a incorporação de exercícios de alcance global demanda uma intensa ativação dos grupos musculares do tronco, os quais desempenham um papel primordial na estabilização corporal. O agachamento, notório por sua complexidade e eficácia na ativação dos estabilizadores durante a execução, suscita uma questão central: se o agachamento recruta de forma mais acentuada a musculatura do tronco comparativamente a exercícios localizados, tais como flexões e extensões do tronco. Objetivo Identificar o grau de ativação dos músculos do tronco durante o agachamento e confrontá-lo com exercícios localizados para a musculatura do tronco: lombar e abdominal. Métodos Através da aplicação da eletromiografia de superfície, avaliou-se a ativação dos músculos iliocostal, multífido, oblíquo interno, oblíquo externo e reto abdominal. A amostra englobou 16 voluntários de ambos os gêneros, fisicamente ativos. Empregou-se um teste t de medidas repetidas (α < 0,05) como método de análise. Resultados Os músculos iliocostal, multífido e oblíquo interno manifestaram níveis semelhantes de ativação tanto no agachamento quanto em seus respectivos exercícios isolados, enquanto os músculos reto abdominal e oblíquo externo apresentaram maior atividade durante a flexão do tronco. Conclusão É possível inferir que o agachamento se configura como um exercício eficaz para o treinamento do iliocostal, multífido e oblíquo interno, enquanto os exercícios localizados se revelam mais indicados para o fortalecimento do oblíquo externo e dos músculos reto abdominais. Tais conclusões podem contribuir para a otimização do planejamento de sessões de exercícios, mediante a substituição de exercícios isolados de tronco pelo agachamento.

Study on the effect of ultrasound intermediate frequency acupoint drug guiding technology on the recovery of gastrointestinal function in patients undergoing lumbar spine surgery / 中国医师进修杂志

Objective:To observe the effects of ultrasound intermediate frequency acupoint targeted drug guiding technology on the recovery of gastrointestinal function and serum gastrin levels in elderly patients after lumbar spine surgery under general anesthesia.Methods:This study used prospective research methods.A total of 90 elderly patients undergoing lumbar spine surgery after general anesthesia in the orthopaedic ward of Beijing Geriatrics Hospital from June 2019 to June 2021 were randomly divided into blank control group, drug control group, and drug-guided treatment group, with 30 cases each group. After the operation, no intervention was given to the blank control group, the drug control group received oral mosapride citrate tablets, the drug-guided treatment group used the D patch to guide the medicine at the two acupoints of Zusanli and Zhongwan with ultrasound medium frequency guided medicine instrument for 1 week each. The serum gastrin levels of the patients in each group were detected 1 d before operation, 3 d after operation, and 1 week after operation, and the time of first exhaust and first defecation after operation were recorded.Results:The results showed that the level of serum gastrin preoperativein the three groups was not significantly different ( P>0.05). On the third day after operation, the levelof serum gastrin in the drug guide treatment group, drug control group and blank control group were lower than those at 1 d before operation: (66.51 ± 5.34) ng/L vs. (69.36 ± 6.50) ng/L, (58.34 ± 5.71) ng/L vs. (68.75 ± 5.13) ng/L, (55.76 ± 6.23) ng/L vs. (70.20 ± 6.71) ng/L, the differences were statistically significant ( P<0.05), and showed a decreasing trend in turn. Among them, the level of serum gastrin in the drug guide treatment group was higher than that in the drug control group and blank control group, the difference was statistically significant ( P<0.05). One week after operation, the level of serum gastrin in the three groups increased compared with the third day after operation ( P<0.05), and the drug guiding treatment group was higher than the drug control group and the blank control group: (72.38 ± 6.78) ng/L vs. (67.15 ± 6.27) ng/L, (63.52 ± 5.38) ng/L, the differences were statistically significant ( P<0.05). The time of first exhaust and defecation after the operation of the three groups of patients, the drug-guided treatment group was significantly shorter than the drug control group and the blank control group: (15.25 ± 3.10) h vs. (20.38 ± 4.21) h and (28.52 ± 3.69) h, (24.14 ± 3.53) h vs. (36.15 ± 3.54) h and (49.51 ± 4.37) h, the differences were statistically significant ( P<0.05). Conclusions:Ultrasound intermediate frequency acupoint drug guiding technology can increase the patient′s serum gastrin level and promote the recovery of gastrointestinal function in elderly patients with lumbar spine surgery after general anesthesia.

Effects of bilateral erector spinae plane block for posterior lumbar spine surgery in elderly patients / 中南大学学报(医学版)

OBJECTIVES@#With the rapid development of aging population, the number of elderly patients undergoing posterior lumbar spine surgery continues to increase. Lumbar spine surgery could cause moderate to severe postoperative pain, and the conventional opioid-based analgesia techniques have many side effects, which are barriers to the recovery after surgery of the elderly. Previous studies have demonstrated that erector spinae plane block (ESPB) could bring about favorable analgesia in spinal surgery. As far as the elderly are concerned, the analgesic and recovery effects of ESPB on posterior lumbar spine surgery are not completely clear. This study aims to observe the effects of bilateral ESPB on elderly patients undergoing posterior lumbar spine surgery, and to improve the anesthesia techniques.@*METHODS@#A total of 70 elderly patients of both sex, who were selected from May 2020 to November 2021, scheduled for elective posterior lumbar spine surgery, and in the age of 60-79 years, with American Society of Anesthesiologists class Ⅱ-Ⅲ, were divided into a ESPB group and a control (C) group using a random number table method, with 35 patients each. Before general anesthesia induction, 20 mL 0.4% ropivacaine was injected to the transverse process of L3 or L4 bilaterally in the ESPB group and only saline in the C group. The score of Numerical Rating Scale (NRS) indicating pain at rest and on movement within 48 h after operation, time of first patient control analgesia (PCA), cumulative consumptions of sufentanil within 48 hours, Leeds Sleep Evaluation Questionnaire (LSEQ) scores on the morning of day 1 and day 2 after operation, Quality of Recovery-15 (QoR-15) scores at 24 and 48 h after operation, full diet intake times, perioperative adverse reactions such as intraoperative hypotension, postoperative dizziness, nausea, vomiting, and constipation were compared between the 2 groups.@*RESULTS@#A total of 70 patients were enrolled and 62 subjects completed the study, including 32 in the ESPB group and 30 in the C group. Compared with the C group, the postoperative NRS scores at rest at 2, 4, 6, and 12 h and on movementat at 2, 4, and 6 h were lower, time of first PCA was later, sufentanil consumptions were significantly decreased during 0-12 h and 12-24 h after operation, LSEQ scores on the morning of day 1 and QoR-15 scores at 24 and 48 h after operation were higher, full diet intakes achieved earlier in the ESPB group (all P<0.05). There were no significant differences in the incidences of intraoperative hypotension, postoperative dizziness, nausea, vomiting, and constipation between the 2 groups (all P>0.05).@*CONCLUSIONS@#Providing favorable analgesic effects with reduced opioids consumption, bilateral ESPB for posterior lumbar spine surgery in the elderly patients could also improve postoperative sleep quality, promote gastrointestinal functional restoration, and enhance recovery with few adverse reactions.

Treatment strategy on traumatic mid-lumbar spondyloptosis with concomitant multiple injuries: A case report and literature review / 中华创伤杂志(英文版)

Spondyloptosis in the clinic is rarely reported. We herein present a 47-year-old female, who suffered from a crush injury directly by a heavy cylindrical object from the lateral side. She was diagnosed to have traumatic L3 spondyloptosis with multiple traumas. Staged surgical procedures were conducted and a three-year follow-up was obtained. Eventually, normal spinal alignment was restored, and neurological deficits were gradually improved. At three years follow-up, the motor strength scores and function of the sphincters were incompletely improved. Previously published reports on traumatic lumbar spondyloptosis were reviewed and several critical points for management of this severe type of spinal injury were proposed. First, thoracolumbar and lumbosacral junction were mostly predilection sites. Second, numerous patients involving traumatic lumbar spondyloptosis were achieved to American Spinal Injury Association grade A. Third, lumbar spondyloptosis was commonly coupling with cauda equina injury. Finally, the outcomes were still with poorly prognosis and recovery of patients was correlation to spondyloptosis severity. Based on this case report and literatures review, we highlighted that the spinal alignment restoration relying on staged operations and following rehabilitation hereof are both important once facing with multiple traumas. Furthermore, we suggested to perform routine CT angiography during lumbar spondyloptosis to justify whether there are large vessel compression or injury.

Curative Effect of Percutaneous Transforaminal Endoscopic Spine System in the Treatment of Lumbar Disc Herniation Complicated with Nerve Root Canal Stenosis / 中山大学学报(医学科学版)

ObjectiveTo explore the clinical efficacy of percutaneous transforaminal endoscopic spine system （TESSYS） in the treatment of lumbar disc herniation （LDH） complicated with nerve root canal stenosis. MethodsA retrospective study was done on 40 LDH patients complicated with nerve root canal stenosis who underwent TESSYS in our hospital from April 2019 to April 2021. The clinical efficacy of the patients was evaluated by the modified Mac Nab criteria 12 months after the surgery. We also measured and analyzed the scores of visual analogue scale （VAS）， Oswestry disability index （ODI） and Japanese orthopaedic association （JOA）， the changes of structural parameters of lumbar spine and inflammatory factor levels preoperatively， 6 and 12 months after the surgery. ResultsAll the 40 cases successfully underwent the surgery and follow-ups， with a 12-month post-operative clinical excellent and good rate of 90%. The preoperative， 6-month and 12-month post-operative VAS scores were （7.38±2.06）， （2.36±0.87） and （1.62±0.82）， respectively. The respective ODI scores were （55.54±11.19）， （26.52±7.61） and （18.14±4.36）； JOA scores （13.93±2.10）， （20.26±1.35） and （22.34±1.88）. The post-operative scores of VAS， ODI and JOA were significantly improved compared with those before the surgery （P<0.05）. The preoperative and post-operative lumbosacral angles were （37.23±6.84）° and （27.37±4.31）°， respectively， with the respective lumbar curvatures of （13.48±3.06） mm and （22.36±4.51） mm. The post-operative lumbosacral angle and lumbar curvature were significantly improved compared with those before the surgery （P<0.05）. The preoperative and post-operative high-sensitivity C-reactive protein （hs-CRP） levels were （3.43±0.61） mg/L and （5.18±0.70） mg/L， respectively， with the respective tumor necrosis factor alpha （TNF-α） levels of （1.44±0.27） mg/L and （2.07±0.44） mg/L. The post-operative levels of hs-CRP and TNF-α were significantly higher than those before the surgery （P<0.05）. ConclusionIn the treatment of LDH complicated with nerve root canal stenosis， TESSYS achieves a good clinical effect， improves the structure and function of the lumbar spine， reduces the degree of lumbar spine pain， and has a mild post-operative inflammatory reaction.

Research progress of Wallis dynamic stabilization system for lumbar degenerative diseases / 中国骨伤

Wallis dynamic stabilization system is a surgical approach in the non-fusion technique of lumbar spine, consisting of interspinous blockers and dacron artificial ligaments that provide stability to the spine while maintaining a degree of motion in the affected segment. Recent studies have demonstrated the significant benefits of Wallis dynamic stabilization system in treating lumbar degenerative diseases. It not only improves clinical symptoms, but also effectively delays complications such as adjacent segmental degeneration. This paper aims to review the literature related to the Wallis dynamic stabilization system and degenerative diseases of the lumbar spine to describe the long-term prognostic effect of this system in the treatment of such diseases. This review provides a theoretical basis and reference for selecting surgical methods to treat degenerative diseases of the lumbar spine.

Dolor lumbar en el embarazo, aspectos fisiopatológicos y tratamiento / Low back pain in pregnancy, pathophysiological aspects and treatment

INTRODUCCIÓN: El dolor lumbar es una condición de alta prevalencia en la población general. La gestación genera cambios fisiológicos que favorecen la aparición de síntomas dolorosos que pueden comprometer la calidad de vida. MÉTODO: Revisión de la literatura con términos MeSH en inglés y español en las bases de datos Embase, PubMed, Lilacs, Sage, Google Academics y Scielo desde el año 1994 hasta el año 2021. Se encontraron 74 artículos y fueron seleccionados 50, basados en su impacto clínico. RESULTADOS: El dolor lumbar afecta a más del 50% de las mujeres embarazadas. Existen antecedentes gineco-obstétricos que pueden intervenirse para disminuir el riego o la intensidad de los síntomas. El diagnóstico es clínico, pero puede asociarse a imágenes diagnósticas cuando se sospechan condiciones de riesgo. El tratamiento se basa en intervenciones no farmacológicas como ejercicio y terapia física, pero pueden utilizarse algunos medicamentos e intervenciones en dolor según su riesgo-beneficio materno y fetal. CONCLUSIONES: El dolor lumbar en el embarazo es muy frecuente y debe ser conocido, diagnosticado y tratado por los profesionales de la salud que atienden esta población, dentro de un equipo multidisciplinario de tratamiento.

INTRODUCTION: Low back pain is a condition of high prevalence in the general population. Gestation generates physiological changes that favor the appearance of painful symptoms that can compromise the quality of life. METHOD: Review of the literature with MeSH terms in English and Spanish in the databases Embase, PubMed, Lilacs, Sage, Google Academics and Scielo from the year 1994 to the year 2021. Seventy-four articles were found and 50 were selected based on their clinical impact. RESULTS: Low back pain affects more than 50% of pregnant women. There are gyneco-obstetric antecedents that can be intervened to reduce the risk or intensity of symptoms. The diagnosis of this entity is clinical, but it can be associated with diagnostic imaging when risk conditions are suspected. Treatment is based on non-pharmacological interventions such as exercise and physical therapy, but some medications and pain interventions can be used according to their risk of maternal and fetal benefit. CONCLUSIONS: Low back pain in pregnancy is very frequent, it should be known, diagnosed, and treated by health professionals who care for this population, based on a multidisciplinary treatment team.

The use of dexmedetomidine in puncture techniques for degenerative diseases of the lumbar spine / Uso de dexmedetomidina em técnicas de punção para doenças degenerativas da coluna lombar / Uso de dexmedetomidina en técnicas de punción para enfermedades degenerativas de la columna lumbar

ABSTRACT Objective To analyze the results of the use of dexmedetomidine (D) in the treatment of patients with degenerative diseases of the lumbar spine using puncture techniques. Methods The study included 77 patients who underwent surgical puncture for degenerative diseases of the lumbar spine with the use of alpha-2-adrenomimetic D: percutaneous laser denervation of the facet joints (n = 46) and posterolateral transforaminal endoscopic discectomy (n = 31). We assessed: the level of sedation using the Ramsay Sedation Scale (RSS) and the Richmond Agitation Sedation Scale (RASS); intraoperative dynamics of the cardiovascular and respiratory system parameters; the level of pain syndrome according to VAS. Results A high intraoperative level of sedation was determined, with RASS -2, -3 and Ramsay III, IV; when transferring a patient to a department (in 90 minutes) this parameter was RASS 0 and Ramsay II. There were no significant changes in central hemodynamics and respiratory depression. The minimum level of pain was determined immediately after surgery, at 30 and 60 minutes after surgery, and before transfer to the department (90 minutes): 6 (4;9); 10 (8;12); 12 (9;13); 16 (13;19) respectively. The absence of the need for additional analgesia on the first postoperative day was verified. Conclusion The use of D significantly reduces the level of pain, while maintaining the necessary verbal contact with the patient, and provides the necessary neurovegetative protection without respiratory depression or lowered hemodynamic parameters during the perioperative period. Level of evidence II; Prognostic Studies - Investigating the Effect of a Patient Characteristic on Disease Outcome. Case series, retrospective study.

RESUMO Objetivo Analisar os resultados do uso de dexmedetomidina (D) no tratamento de pacientes com doenças degenerativas da coluna lombar com técnicas de punção. Métodos O estudo incluiu 77 pacientes submetidos à punção cirúrgica em doenças degenerativas da coluna lombar com o uso de um agonista alfa-2 adrenérgico: denervação percutânea das articulações facetárias com laser (n = 46) e discectomia endoscópica transforaminal posterolateral (n = 31). Foram avaliados o nível de sedação usando a Escala de Sedação de Ramsay (RSS) e a Escala de Sedação e Agitação de Richmond (RASS); a dinâmica intraoperatória dos parâmetros dos sistemas cardiovascular e respiratório; o nível de síndrome de dor de acordo com a EVA. Resultados Determinou-se um alto nível intraoperatório de sedação pela RASS (-2, -3) e pela Ramsay (III, IV). Ao transferir um paciente para outro setor (depois de 90 minutos), esse parâmetro era 0 em RASS e II em Ramsay. Não houve alterações significativas na hemodinâmica central e na depressão respiratória. O nível mínimo de dor foi determinado imediatamente após a cirurgia, 30 e 60 minutos depois da cirurgia e antes da transferência para o outro setor (90 minutos depois): 6 (4; 9); 10 (8; 12); 12 (9; 13); 16 (13; 19), respectivamente. Constatou-se que não era necessária analgesia adicional no primeiro dia pós-operatório. Conclusões O uso de D reduz significativamente o nível de dor mantendo a comunicação verbal necessária com o paciente e fornece a proteção neurovegetativa necessária sem depressão respiratória e os parâmetros hemodinâmicos reduzidos durante o período perioperatório. Nível de evidência II; Estudos prognósticos - Investigação do efeito de característica de um paciente sobre o desfecho da doença. Série de casos, Estudo retrospectivo.

RESUMEN Objetivo Analizar los resultados del uso de dexmedetomidina (D) en el tratamiento de pacientes con enfermedades degenerativas de la columna lumbar con técnicas de punción. Métodos El estudio incluyó a 77 pacientes con enfermedades degenerativas de la columna lumbar que se sometieron a punción quirúrgica mediante el uso de un agonista adrenérgico alfa-2: denervación percutánea de las articulaciones facetarias con láser (n = 46) y discectomía endoscópica transforaminal posterolateral (n = 31). Fueron evaluados el nivel de sedación mediante la Escala de Sedación de Ramsay (RSS) y la Escala de Sedación y Agitación de Richmond (RASS); la dinámica intraoperatoria de los parámetros de los sistemas cardiovascular y respiratorio; el nivel del síndrome de dolor según la EVA. Resultados Se determinó un alto nivel de sedación intraoperatoria en RASS (-2, -3) y por Ramsay (III, IV)Al transferir un paciente a otro sector (después de 90 minutos), este parámetro fue 0 en RASS y II en Ramsay. No hubo cambios significativos en la hemodinámica central y la depresión respiratoria.El nivel mínimo de dolor se determinó después de la cirugía, 30 y 60 minutos después de la cirugía y antes del traslado al otro sector (90 minutos después): 6 (4; 9); 10 (8; 12); 12 (9; 13); 16 (13; 19), respectivamente. Se verificó que no era necesaria analgesia adicional el primer día postoperatorio. Conclusiones El uso de D reduce significativamente el nivel de dolor al mismo tiempo que se mantiene la necesaria comunicación verbal con el paciente y brinda la protección neurovegetativa necesaria sin depresión respiratoria y parámetros hemodinámico reducidos durante el período perioperatorio. Nivel de evidencia II; Estudios de pronóstico: Investigación del efecto de la característica de un paciente sobre el desenlace de la enfermedad. Serie de casos, Estudio retrospectivo.

Análisis biomecánico de la ligamentoplastía interespinosa con fibra de poliéster posterior a discectomía / Biomechanical analysis of interespinous ligamentoplasty with polyester fiber after discectomy

Resumen: Introducción: Existen diferentes patologías de la columna lumbar que condicionan una inestabilidad biomecánica y clínica para su tratamiento, se han efectuado diversas técnicas de estabilización que tratan de preservar el movimiento y la transmisión de carga del segmento afecto como la ligamentoplastía interespinosa con fibra Dallos®. Objetivo: Mostrar las variaciones biomecánicas de segmento funcional de columna lumbar de porcino, antes y después de realizar la discetomía y ligamentoplastía con fibra Dallos®. Material y métodos: El segmento lumbar se montó en un simulador multiaxial servo-hidráulico. Se simularon rangos de movilidad de flexión, extensión, flexiones laterales y rotaciones axiales en tres condiciones: 1) segmento natural; 2) segmento discectomizado; y 3) segmento disectomizado más ligamentoplastía con fibra Dallos®. Los rangos de movilidad se realizan hasta un torque de 7.5 N-m. La data de los torques y rangos de movilidad se recolectó en el programa del simulador y se graficaron los resultados de los cambios biomecánicos entre las tres condiciones descritas. Resultados: Se demostró que la biomecánica lumbar es afectada después de la discectomía principalmente en la flexión y la extensión. En los movimientos de flexión y rotación axial izquierdas, se comprobó una alteración del torque y los rangos de movilidad. Conclusiones: La ligamentoplastía recupera parte de la estabilidad perdida postdiscectomía, preservando parte de la altura discal sin llegar a igualar los movimientos como en el segmento natural. Posterior a la discectomía, la distribución de la fuerza sugiere que la inestabilidad residual con ligamento plastía puede representar sobrecarga facetaria.

Abstract: Introduction: There are different pathologies of the lumbar spine that condition a biomechanical and clinical instability for its treatment, various stabilization techniques have been carried out that try to preserve the movement and the transmission of load of the affected segment such as the interspinatus ligamentplasty with Dallos® fiber. Objective: To show the biomechanical variations of functional segment of lumbar spine of pigs, before and after performing the discectomy and ligamentoplasty with Dallos® fiber. Material and methods: The lumbar segment was mounted in a servo-hydraulic multiaxial simulator. Mobility ranges of flexion, extension, lateral flexion and axial rotations were simulated under three conditions: 1. Natural segment, 2. Discectomy segment, and 3. Disectomized segment plus ligamentoplasty with Dallos® fiber. The mobility ranges are made up to a torque of 7.5 N-m The data of the torques and mobility ranges was collected in the simulator program and the results of the biomechanical changes between the three conditions described were plotted. Results: It was shown that lumbar biomechanics is affected after discectomy mainly in flexion and extension. In the left axial bending and rotation movements, an alteration of torque and mobility ranges was found. Conclusions: The ligamentoplasty recovers part of the stability lost after discectomy preserving part of the disc height without reaching to equalize the movements as in the natural segment. After discectomy the distribution of force suggests that residual instability with ligament plasty may represent facet overload.

Quantitative evaluation of lumbar spine osteoporosis by apparent diffusion coefficient and signal intensity ratio of magnetic resonance diffusion-weighted magnetic resonance imaging / 中国骨伤

OBJECTIVE@#To investigate the application value of apparent diffusion coefficient (ADC) and signal intensity ratio (SIR) of MR diffusion-weighted imaging (DWI) in quantitative evaluation of lumbar spine osteoporosis.@*METHODS@#A total of 175 patients with lumbar spine diseases who received dualenergy X-ray absorption (DXA) bone mineral density (BMD), routine MRI and DWI of the lumbar spine from May 2017 to October 2019 were selected. According to the T-value of DXA, the patients were divided into osteoporosis group (64 cases), osteopenia group (53 cases) and normal bone mass group (58 cases). The ADC and SIR values of L@*RESULTS@#There were statistically significant differences in ADC and SIR values among three groups (@*CONCLUSION@#ADC and SIR can better reflect the BMD of patients with lumbar diseases, and can quantitatively evaluate the vertebral body of osteoporosis, which play an important role in the diagnosis of lumbar osteoporosis.

Safety dose of bone cement in vertebroplasty assessed by mimics software / 中国组织工程研究

BACKGROUND: With the increasing number of osteoporosis vertebrae compression fracture patients, it is difficult to reach a consensus on how much bone cement is given in percutaneous kyphoplasty surgery. OBJECTIVE: To investigate the relationship of different doses of bone cement with clinical efficacy and bone cement leakage using Mimics software, and to explore the safe and effective bone cement injection threshold in percutaneous kyphoplasty for cases with osteoporosis vertebrae compression fracture. METHODS: Forty-three patients with osteoporosis vertebrae compression fracture undergoing percutaneous kyphoplasty were included and randomly divided into two groups. The amount of bone cement injected into the vertebral body and the volume of vertebral body were designed by Mimics software. The volume ratio of bone cement was calculated according to the average volume of upper and lower vertebrae. In groups A and B, 24% and 15% of bone cement were injected according to the bone cement volume ratio (bone cement volume/vertebral volume ratio) recognized by most documents. The differences of pain, leakage rate, Cobb’s angle and refracture rate between the two groups were evaluated by follow-up. RESULTS AND CONCLUSION: (1) All patients were followed up for 6-24 months. (2) There were significant differences in visual analogue scale score between the two groups between preoperation and at each time point after operation, the first day after operation and the fifth day (before discharge), three months and 12 months after operation (P 0.05). (3) There were 5 cases (24%) with leakage in group A and 2 cases (10%) in group B; there was no significant difference in the leakage rate of bone cement between the two groups (P > 0.05). (4) There were significant differences in Cobb’s angle between the two groups between different time points after operation and preoperation (P 0.05). (5) There were 3 cases of refracture in group A (14%) and 2 cases in group B (10%). There was no significant difference between the two groups (P > 0.05). (6) Above results confirm that it was accurate for us to evaluate bone cement volume according to the fracture vertebral body volume by 15% and 24% injection of bone cement using Mimics software, which showed less complications and short-term satisfactory clinical efficacy.

Articulación facetaria lumbar: correlación anatómica, clínica e imagenológica / Lumbar facet joint: anatomical, clinical and imaging correlation

El dolor facetario lumbar es una de las principales causas de dolor lumbar; representa alrededor del 15-56%. La articulación facetaria estabiliza la columna vertebral, tiene un rol fundamental en el soporte, distribución del peso y regulación de los movimientos rotacionales de la columna. Por ello, el conocimiento de la anatomía y de la biomecánica de esta articulación ayuda a tener una mejor comprensión de su participación en la fisiopatología del dolor lumbar y, por ende, mejora su abordaje diagnóstico y terapéutico. Nosotros revisamos aquí los conceptos actuales de embriología, anatomía, biomecánica y la correlación clínica/imagenológica de los cambios asociados a la enfermedad degenerativa facetaria de la columna lumbar.

Low back pain is a very common reason for emergency room consultation, it is found in approximately 60% of adults, and, within it, facet lumbar pain is one of the main causes, accounting for about 15-56% of low back pain cases. The facet joint stabilizes the spine, helps to distribute loads and has a fundamental role in support, weight distribution, and rotational movements regulation of the spine. Consequently, knowledge of the anatomy and biomechanics of this joint is helpful to have a better understanding of their contribution to the low back pain pathophysiology and, therefore, improving diagnostic and therapeutic approaches. This paper aims to review the current concepts of embryology, anatomy, biomechanics, and clinical/imaging correlation of the changes associated with lumbar degenerative facet disease

Effect Of Lumbar Spine Manipulation On Menstrual Distress

Background: Menstrual distress is characterized by crampy pelvic pain beginning before or at onset of menstruation, abdominal pain, bloating, headache, backache, irritability, depression, anxiety, mood changes, fatigue and sleep disturbances. Primary dysmenorrhea is defined as recurrent, painful menses in women in the absence of an identifiable pelvic pathology. Secondary dysmenorrheais menstrual pain associated with underlying pelvic pathology. The aim of the study was to find the efficacy of lumbar spine manipulation on menstrual distress. Methods: The study was a cross-sectional study. Menstrual Distress Questionnaire (MDQ) and Numerical Pain Rating Scale (NRS) were used as an outcome measure. The lumbar spine manipulation technique was given to the participants. Results: The post lumbar manipulation technique showed the significant improvement in menstrual distress symptoms along with significant improvement in backache, headache, abdominal discomfort and work absenteeism. Conclusion: The lumbar spine manipulation is effective in relieving menstrual distress symptoms.

Minimally invasive transforaminal lumbar interbody fusion in the treatment of sciatic scoliosis caused by lumbar disc herniation: A 2-year follow-up of coronal and sagittal balance / 中国组织工程研究

BACKGROUND: The sciatic scoliosis is considered as a compensatory attempt of the body to relieve nerve irritation. If dealt with inappropriate and delayed, it may be developed in structural scoliosis. There was controversial about the treatment of such cases. OBJECTIVE: To compare the safety and effectiveness of single-level open versus minimally invasive transforaminal lumbar interbody fusion in the treatment of sciatic scoliosis caused by lumbar disc herniation. METHODS: Data of 47 patients with sciatic scoliosis caused by lumbar disc herniation who were treated in Peking University People’s Hospital from January 2010 to January 2014 were retrospectively analyzed. The main symptom was severe back and lower limb pain, complicated with trunk tilt. Twenty-five patients underwent single-level open transforaminal lumbar interbody fusion therapy (open group). Twenty-two patients underwent minimally invasive transforaminal lumbar interbody fusion therapy (minimal invasion group). The single-level surgery was conducted in both groups. The patients were followed up for at least 2 years. The clinical effects and photographic parameters were compared between the two groups. RESULTS AND CONCLUSION: (1) There was no significant difference in age, gender, spinal levels operated and all the coronal and sagittal parameters preoperatively between the two groups (P > 0.05). (2) There was no significant difference in operation time between the two groups (P >0.05). The amount of bleeding, postoperative time to the ground, and average length of hospital stay were better in the minimal invasion group than in the open group (P 0.05). (4) Balance of coronal plane and sagittal plane: The deformity at 2 years after operation was significantly improved compared with that before operation (P 0.05). (5) Solid fusion was achieved in both groups. (6) It is concluded that minimally invasive transforaminal lumbar interbody fusion in the treatment of single-level sciatic scoliosis caused by lumbar disc herniation obtained similar effect as open fusion. Moreover, it has the advantages of less bleeding, faster recovery and shorter hospital stay.

Biomechanical characteristics of the lumbar disc after fatigue injury / 中国组织工程研究

BACKGROUND: Lumbar disc herniation is a common clinical disease, and its pathological basis is disc degeneration. Long-term mechanical load is considered to be an important cause of lumbar disc degeneration. Because the occurrence of lumbar disc herniation is strongly associated with its mechanical state, it is necessary to further study the stress/strain behavior in the lumbar disc to provide inspiration for preventing lumbar disc herniation. OBJECTIVE: To analyze the effect of fatigue loading on mechanical properties of the whole and different regions of the intervertebral disc. METHODS: The freshly slaughtered sheep lumbar intervertebral discs L1-L2, L3-L4, and L5-L6 were obtained and made into experimental samples. The experimental samples were fixed on the experimental platform through the upper and lower vertebrae, and a quasi-static compression-cyclic loading compression-quasi-static compression experiment was performed. The L3-L4 motion segment was cut parallel to the sagittal plane, and the non-contact digital image correlation technique was used to record the internal deformation of the lumbar disc during compression. RESULTS AND CONCLUSION: (1) The results showed that all lumbar intervertebral discs exhibited non-linear load-displacement and stress-strain characteristics. (2) Effect of fatigue loading: The Young’s modulus of the lumbar intervertebral disc increased significantly after fatigue loading. (3) Impact of segment changes: The Young’s modulus changed with segment changes as follows: L5-L6 segments < L3-L4 segments < L1-L2 segments. (3) Effect of loading rate: Comparing the mechanical properties under the compression rate of 0.01 mm/s and 0.1 mm/s, it could be seen that with the increase of the compression rate, the Young’s modulus of the intervertebral disc increased significantly. (5) Internal displacement distribution: Fatigue loading had a significant effect on the internal displacement distribution of the lumbar disc under compression. Before fatigue loading, the axial displacement in upper afferent fiber was largest, and the radial displacement in inner afferent fiber was slightly smaller than that in outer afferent fiber. After fatigue loading, the axial displacement in upper afferent fiber was smallest, and the radial displacement in inner afferent fiber was significantly smaller than in outer afferent fiber. (6) The research work in this article has important theoretical guiding significance for preventing lumbar disc herniation in daily life.

Comparison of biomechanical characteristics of lumbar spine after unilateral and bilateral internal fixation / 中国组织工程研究

BACKGROUND: Pedicle screw fixation is the preferred surgical treatment for clinical treatment of lumbar degenerative disease currently. The stability of pedicle screw fixation system can be evaluated from the perspective of biomechanics and finite element method is more and more popular in analyzing stress of pedicle screw fixation of vertebral body for researchers. OBJECTIVE: To analyze the stress and displacement changes of human lumbar spine in bending movement from the biomechanical point of view when unilateral and bilateral pedicle screws are fixed, providing theoretical reference for practical clinical application. METHODS: Three-dimensional models were established based on CT data of the volunteers. The volunteers signed the informed consent. This study was approved by the Hospital Ethics Committee. Abaqus software was used to simulate the actual stress conditions. Finite element analysis of lumbar spine flexion was performed during unilateral and bilateral pedicle screw fixation. The stress and displacement of lumbar vertebra, disc and pedicle screw were observed under two fixation methods. RESULTS AND CONCLUSION: (1) Under bilateral fixation, the stress on the left screw was 22.2 MPa, and the stress on the right screw was 21.14 MPa, which was far less than the stress of the screw under unilateral fixation (79.19 MPa). The stress of intervertebral disc in unilateral fixation was 87% larger than that in bilateral fixation; the stress of vertebral body in bilateral fixation was 72% smaller than that in unilateral fixation. (2) From the perspective of displacement, the displacement of screw, lumbar disc and centrum under bilateral fixation were 53%, 55% and 62% smaller than that under unilateral fixation, respectively. (3) Therefore, from the mechanical point of view, bilateral pedicle screw fixation has less stress level, which is friendlier to the human body than unilateral fixation and thus more conducive to the recovery of patients.

Mechanical responses of the degenerated lumbar spines with different degrees at low frequency vibration generated by vehicle driving using finite element analysis / 中国组织工程研究

BACKGROUND; Long-term exposure to low-frequency vibration environment generated by vehicle driving is harmful to human lumbar health, and parts of drivers have suffered from lumbar degeneration. However, the damage mechanism of low-frequency vibration generated by vehicle driving on degenerated lumbar spines with different grades has not been studied clearly. OBJECTIVE; To determine the effects of low-frequency vibration on the degenerated lumbar spines with different degrees by comparing the mechanical responses of the same lumbar spine under the vibrations at different frequencies and different lumbar spines under the same vibration. METHODS; To simulate the mechanical responses of lumbar spines under low-frequency vibration, four typical finite element models of human lumbar spine with different degrees of degeneration were established, and low-frequency vibrations generated by vehicle driving were applied on these models. RESULTS AND CONCLUSION: (1) The damping effects of four lumbar spines were better under a short period of vibration, but the mechanical properties of the moderately and severely degenerated lumbar spines degraded significantly when the vibration time was long. Therefore, the drivers with moderately and severely degenerated lumbar spines were not suitable for long-term low-frequency vibration. (2) As the degree of lumbar degeneration aggravated, the lumbar natural frequency gradually decreased. (3) Excluding the resonant frequency, the changes in the mechanical properties of the same lumbar spine under the vibrations at different frequencies were tiny, suggesting that no differences in the mechanical performance of lumbar spine existed when driving on different well-paving roads in one vehicle.

Biomechanical analysis of different fixation methods of pedicle screws for thoracolumbar fracture / 中国组织工程研究

BACKGROUND: Percutaneous fixation of thoracolumbral and lumbar fractures has been relatively mature, and there are many clinical fixation methods at present. However, due to the lack of a fixation method that can take the mechanical effect and operability into account, the clinical efficacy is different. OBJECTIVE: To study the biomechanical properties of lumbar vertebrae under the different kinds of pedicle screw fixation. METHODS: Twenty-four cases of fresh multi-segment lumbar vertebrae of pigs were randomly divided into eight groups and modeled: groups A1 and A2 were fixed with six universal screws; groups B1 and B2 were fixed with four one-way screws and two universal screws; groups C1 and C2 were fixed with six uniplanar pedicle screw; groups D1 and D2 were fixed with four one-way screws. The biomechanics of eight groups was measured by universal testing machine. Four groups of A1, B1, C1 and D1 performed static experiments, while A2, B2, C2 and D2 performed fatigue experiments. RESULTS AND CONCLUSION: (1) All the four internal fixations could effectively fix lumbar fractures. The maximum load of the screw fixation at the fracture level was significantly higher in the screw placement group than that of unscrew placement group. Group C1 had the largest load, and group D1 had the smallest load, and there were significant differences among the four groups (P < 0.05). (2) Groups A1, B1, C1 and D1 conducted pressurized buttoning experiments, and the three groups B1, C1 and D1 all completed the buttoning experiments three times. The A1 group showed the slip of the nail tail when pressurized 300 N. The reduction effect of group C1 was better than that of groups A1, B1 and D1, and the difference was statistically significant (P < 0.05). The reduction effect of group B1 was better than that of groups A1 and D1, and the difference was statistically significant (P < 0.05). There was no significant difference in reduction effect between groups A1 and D1. (3) There was no significant difference in the anterior vertebral body height in groups B2, C2 and D2 after loading compared with that before loading. After loading, the anterior vertebral body height in group A2 was significantly lower than that before loading (P < 0.05). (4) All three kinds of pedicle screws can bear most of the stress of thoracolumbar vertebra, and the screw placement mode of injured vertebra can provide more effective stability and better shape recovery of injured vertebra. The effect of the uniplanar pedicle screw is better than that of the other three fixation screws.

Minimally invasive transforaminal lumbar interbody fusion for treatment of single-segment lumbar spinal stenosis improves lumbar-pelvic balance / 中国组织工程研究

BACKGROUND: More and more studies have shown that lumbar-pelvic parameters are closely related to the clinical effect and adjacent segment degeneration after lumbar fusion, but the effect of minimally invasive transforaminal interbody fusion on lumbar-pelvic parameters is not clear. OBJECTIVE: To evaluate the effect of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) on the lumbar-pelvic imaging parameters in patients with single-segment lumbar spinal stenosis. METHODS: The clinical data of 85 patients with single-segment lumbar spinal stenosis treated by MIS-TLIF and open-TLIF in the First Affiliated Hospital of Dali University from January 2015 to January 2017 were retrospectively analyzed, including 39 cases of MIS-TLIF operation (MIS-TLIF group) and 46 cases of open-TLIF operation (open-TLIF group). On the standing lateral lumbar X-ray containing bilateral femoral heads: lumbar lordosis, segmental lordosis, height of the intervertebral disc, the L1 axis and S1 distance, pelvic incidence, pelvic tilt, and sacral slope were measured, and the difference between pelvic incidence−lumbar lordosis and the ratio of lumbar lordosis/pelvic incidence were calculated. RESULTS AND CONCLUSION: (1) During the last follow-up, lumbar lordosis, height of the intervertebral disc, and sacral slope were increased in both groups compared with preoperative parameters, but pelvic tilt was decreased compared with preoperatively, and the difference was significant (P 0.05). (2) During the last follow-up, lumbar lordosis, segmental lordosis, height of the intervertebral disc, pelvic incidence, pelvic tilt, sacral slope, and the L1 axis and S1 distance were not significantly different compared with preoperative parameters (P > 0.05). (3) The difference between pelvic incidence−lumbar lordosis was significantly decreased at the last follow-up compared with preoperative parameters in the two groups (P 0.05). (4) Above results indicated that for single-segment lumbar spinal stenosis, MIS-TLIF has the same effect as open-TLIF in recovery of lumbar lordosis, intervertebral height, and improving lumbar-pelvic balance.

Finite element analysis of lumbar interbody fusion combined with adjacent-segment semi-rigid fixation / 中国组织工程研究

BACKGROUND: The clinical occurrence of lumbar degenerative diseases is often accompanied by multi-segments lesions. To slow down the degeneration of adjacent segments after lumbar fusion, lumbar hybrid surgery has become a better choice. In the past clinical observation, WavefleX system has achieved a certain effect on single segment. Its application in lumbar hybrid surgery lacks the support of biomechanical research results. OBJECTIVE: To analyze the biomechanical effects of lumbar fusion combined with WavefleX system on adjacent segments by the finite element method. METHODS: A 64-row Siemens spiral CT machine was used to scan the lumbar spine of a stationary supine volunteer with a scanning range of T11-S1. This voluntter signed the informed consent. This study was approved by the Hospital Ethics Committee. L3-5 horizontal scanning data were imported into the Mimics medical image processing software and the Geomagic studio reverse engineering software for processing. L3-5 lumbar spine solid model was constructed in the CAD software SCDM. On the basis of L3-5 lumbar model, posterior lumbar interbody fusion model and Hybrid model were constructed respectively. Assignment and load loading were conducted in three models. The finite element analysis was carried out under the conditions of forward flexion, backward extension, lateral flexion and rotation. RESULTS AND CONCLUSION: (1) Compared with posterior lumbar interbody fusion model, the stress value of L3-4 disc in Hybrid model decreased significantly in forward flexion, backward extension, lateral flexion and rotation, and the maximum value decreased about 46% in extension. (2) Compared with posterior lumbar interbody fusion model, the range of motion of L3-4 segment in Hybrid model decreased significantly, with an average decrease of about 26%, which was smaller than that of the complete model under all conditions. (3) Under each load, the stress nephogram showed that there was an obvious stress concentration on the connecting rod of WavefleX system, and the stress at the U-shaped groove concave of the elastic system on both sides was significantly increased. (4) Displacement nephogram showed the placement of WavefleX system in Hybrid model, which made its forward bending center moved back to the elastic structure. (5) The above results show that posterior lumbar interbody fusion + WavefleX semi-rigid fixation can effectively reduce the stress of the last adjacent segment of the disc and limit the excessive activity, maintain the normal movement characteristics of the lumbar spine to a certain extent.