3D navigation assisted percutaneous vertebroplasty combined with postoperative lower-back muscles training in treatment of osteoporotic vertebral compression fracture / 中国介入影像与治疗学

Objective: To observe value of 3D navigation assisted percutaneous vertebroplasty (PVP) combined with postoperative lower-back muscles training in treatment of osteoporotic vertebral compression fracture (OVCF). Methods: Twenty-five consecutive patients with OVCF were enrolled in observation group and treated with 3D navigation assisted PVP using O-arm scanner and postoperatively systematic back muscle exercise, while other 25 OVCF patients in control group were treated with traditional C-arm assisted PVP and postoperatively regular back muscle exercise. Intraoperative fluoroscopy time, mean dose of radiation, mean procedure time, visual analogue score (VAS) before and 2 h, 1 month, 3 months, 6 months after operation were compared between the two groups. Technical success rate was calculated, and vertebral leakages and complications were observed. Results: Technical success rate of the two groups were both 100% (25/25). The duration of fluoroscopy and operation were shorter, the radiation dose was lower in observation group (all P0.05). Conclusion: PVP guided with 3D navigation combined with postoperative lumbar and dorsal muscle training can safely and effectively treat OVCF, shorten the operation time, reduce radiation exposure and improve the medium and long-term pain symptoms after PVP.

Scoring System for Factors Affecting Aggravation of Lumbar Disc Herniation

PURPOSE: To investigate the various imaging factors associated with aggravation of lumbar disc herniation (LDH) and develop a scoring system for prediction of LDH aggravation. MATERIALS AND METHODS: From 2015 to 2017, we retrospectively reviewed the magnetic resonance imaging (MRI) findings of 60 patients (30 patients with aggravated LDH and 30 patients without any altered LDH). Imaging factors for MRI evaluation included the level of LDH, disc degeneration, back muscle atrophy, facet joint degeneration, ligamentum flavum thickness and interspinous ligament degeneration. Flexion-extension difference was measured with simple radiography. The scoring system was analyzed using receiver operating characteristic (ROC) analysis. RESULTS: The aggravated group manifested a higher grade of disc degeneration, back muscle atrophy and facet degeneration than the control group. The ligamentum flavum thickness in the aggravated group was thicker than in the group with unaltered LDH. The summation score was defined as the sum of the grade of disc degeneration, back muscle atrophy and facet joint degeneration. The area under the ROC curve showing the threshold value of the summation score for prediction of aggravation of LDH was 0.832 and the threshold value corresponded to 6.5. CONCLUSION: Disc degeneration, facet degeneration, back muscle atrophy and ligamentum flavum thickness are important factors in predicting aggravation of LDH and may facilitate the determination of treatment strategy in patients with LDH. The summation score is available as supplemental data.

Relationship between Lumbar Disc Degeneration and Back Muscle Degeneration / 대한척추외과학회지

STUDY DESIGN: Retrospective evaluation. OBJECTIVES: To determine the relationship between lumbar disc degeneration and back muscle degeneration. SUMMARY OF LITERATURE REVIEW: In the degenerative cascade of the spine described by Kirkaldy-Willis, degeneration of the disc and of the facet joint co-occur with aging. However, the muscles of the back are not included in this model. Several studies have reported significant correlations between back muscle degeneration and facet joint arthritis. The purpose of our study was to evaluate relationships between lumbar disc degeneration and fatty degeneration of the back muscles. MATERIALS AND METHODS: In this study, 65 patients over the age of 50 years who had undergone lumbar spine MRI in our orthopaedic clinic were recruited. Fatty degeneration of the back muscles was qualitatively graded from I to III by the degree of the fat signal in the muscle layer, including both the multifidus and erector spinae. Lumbar disc degeneration was graded from I to V according to the Pfirrmann grade. Correlations between the back muscle degeneration grade and radiological parameters were analyzed. RESULTS: The degeneration grade of the multifidus correlated positively with age and the grade of disc degeneration. Correlations with other radiologic parameters were not significant. The degeneration grade of the erector spinae correlated positively with age. Other radiologic parameters were not significant. CONCLUSIONS: There was a significant correlation between lumbar disc degeneration and multifidus degeneration. Erector spinae degeneration was correlated with age, but not with lumbar disc degeneration. The degenerative cascade of the spine was accompanied by fatty changes of the multifidus with aging.

Activity of Back and Foot Muscles during Lateral Weight-Shifting in the Standing Position / The Japanese Journal of Rehabilitation Medicine

<p>【Objective】</p><p>To investigate the role of the back and foot muscles during lateral weight-shifting in the standing position by examining the corresponding muscle activity patterns associated with a postural change.</p><p>【Methods】</p><p>The subjects were 24 healthy men (age 24.3 ± 2.6 [mean ± SD] years). The following parameters were recorded : center of pressure (COP) ; surface electromyograms of the multifidus, iliocostalis, longissimus (bilateral), peroneus, and foot supinator (on the moving side) muscles ; and video imaging during lateral weight-shifting after 2 seconds in the standing position.</p><p>【Results】</p><p>Horizontal movement of the pelvis resulted in elevation of the non-moving side from the middle of the COP, with moving side displacement. In the lower limbs, lateral weight shifting resulted in an outward tilt due to foot pronation. Activity of the multifidus, iliocostalis, and longissimus muscles on the non-moving side, and the peroneus and foot supinator muscles on the moving side, tended to increase with displacement of the COP on the moving side.</p><p>【Conclusion】</p><p>The multifidus, iliocostalis, and longissimus muscles were involved in lateral flexion of the thoracolumbar area and elevation of the pelvis on the non-moving side. Simultaneously, the foot supinator and peroneus muscles were involved in pronation of the grounded foot.</p>

Risk Factors of Proximal Junctional Kyphosis after Multilevel Fusion Surgery: More Than 2 Years Follow-Up Data

OBJECTIVE: Proximal junctional kyphosis (PJK) is radiologic finding, and is defined as kyphosis of >10° at the proximal end of a construct. The aim of this study is to identify factors associated with PJK after segmental spinal instrumented fusion in adults with spinal deformity with a minimum follow-up of 2 years. METHODS: A total of 49 cases of adult spinal deformity treated by segmental spinal instrumented fusion at two university hospitals from 2004 to 2011 were enrolled in this study. All enrolled cases included at least 4 or more levels from L5 or the sacral level. The patients were divided into two groups based on the presence of PJK during follow-up, and these two groups were compared to identify factors related to PJK. RESULTS: PJK was observed in 16 of the 49 cases. Age, sex and mean follow-up duration were not statistically different between two groups. However, mean bone marrow density (BMD) and mean back muscle volume at the T10 to L2 level was significantly lower in the PJK group. Preoperatively, the distance between the C7 plumb line and uppermost instrumented vertebra (UIV) were no different in the two groups, but at final follow-up a significant intergroup difference was observed. Interestingly, spinal instrumentation factors, such as, receipt of a revision operation, the use of a cross-link, and screw fracture were no different in the two groups at final follow-up. CONCLUSION: Preoperative BMD, sagittal imbalance at UIV, and thoracolumbar muscle volume were found to be strongly associated with the presence of PJK.

Impact of Mild Asphyxia in Delivery on Motor Development / 中国康复理论与实践

@#Objective To explore the impact of intrapartum mild asphyxia on motor development in infants. Methods 30 infants with any of the following were as asphyxia group: heart rate more than 160 beats/min in the process of childbirth, and then down to 70-80 beats/ min, no cyanose; Apgar score 1 min more than 8. Other 30 normal infants were as control group. They were assessed with Neuropsychological Development Scale for 0-6 Years Old 3, 6 and 9 months after birth. Results Opisthotonos was more frequent in the asphyxia group than in the control group (P<0.01) 3 months after birth, but there was no significant difference in total score (P>0.05). Sitting forward was more frequent in the asphyxia group 6 months after birth, and the score of motor was less in the asphyxia group than in the control group (P< 0.05). More of the asphyxia group couldn't stand with help, and with poor motor score 9 months after birth (P<0.05). Conclusion Intrapartum mild asphyxia may infulence the motor development of infant in long-term.

What Is the Effect of Spino-Pelvic Sagittal Parameters and Back Muscles on Osteoporotic Vertebral Fracture?

STUDY DESIGN: Case control study. PURPOSE: To examine the effect of spino-pelvic sagittal parameters and back muscles on osteoporotic vertebral fracture. OVERVIEW OF LITERATURE: Low bone mass is not the only important component of the risk on osteoporotic vertebral fracture; many other risk factors also contribute to skeletal fragility. METHODS: Seventy-two patients who had a lateral radiograph of the whole spine, magnetic resonance imaging of the lumbar spine, and bone densitometry, were enrolled. The spino-pelvic sagittal parameters (pelvic incidence, pelvic tilt [PT], sacral slope, thoracic kyphosis, lumbar lordosis), age, lumbar bone mineral density, and amount of back muscle around the lumbar spine were analyzed. RESULTS: There was higher sagittal imbalance of the spine in the vertebral fracture group (p=0.011). In spinopelvic parameters, the average of PT was 22.13degrees in vertebral fracture group and 13.70degrees in the non-fracture group (p=0.002). The amount of lower back extensor muscle in the vertebral fracture group was 2,170 mm2, which was lower than the non-fracture group (3,040 mm2, p=0.001). Multiple logistic regression analysis for the risk of osteoporotic vertebral fracture was significant in lumbar bone mineral density (odds ratio [OR], 0.313; 95% confidence interval [CI], 0.139-0.706, p=0.005) and the muscle ratio of extensor back muscle (OR, 0.902; 95% CI, 0.826-0.984; p=0.020). CONCLUSIONS: These results suggest that osteoporotic vertebral fracture could be developed easily by weakness of extensor back muscle in sagittal imbalance of the spine with high pelvic tilt.

Impact of Mild Asphyxia in Delivery on Motor Development / 中国康复理论与实践

Objective To explore the impact of intrapartum mild asphyxia on motor development in infants. Methods 30 infants with any of the following were as asphyxia group:heart rate more than 160 beats/min in the process of childbirth, and then down to 70-80 beats/min, no cyanose;Apgar score 1 min more than 8. Other 30 normal infants were as control group. They were assessed with Neuropsychologi-cal Development Scale for 0-6 Years Old 3, 6 and 9 months after birth. Results Opisthotonos was more frequent in the asphyxia group than in the control group (P0.05). Sitting forward was more frequent in the asphyxia group 6 months after birth, and the score of motor was less in the asphyxia group than in the control group (P<0.05). More of the asphyxia group couldn't stand with help, and with poor motor score 9 months after birth (P<0.05). Conclusion Intrapar-tum mild asphyxia may infulence the motor development of infant in long-term.

Clinical Observation of Zhuang Medicine Tendons Therapy on Back Muscle Fasciitis / 浙江中医药大学学报

Objective] To observe Zhuang medicine tendons back muscle fasciitis therapy clinical efficacy.[Methods] 90 patients were treated randomly and divided into treatment group and control group. Treatment group, Zhuang medicine tendons therapy(massage and tendons fire needle + Zhuang medicine cupping); control group using traditional Chinese medicine therapy(Chinese massage techniques+EA+cupping) treatment once every other day, five times as a course, of two courses, and observe the effect. [Results] The treatment group: the total efficiency 93.33%; control group: the total effective rate 71.11%. The total effective rates had difference( P<0.05), the difference was statistical y significant. [Conclusion] Zhuang medicine tendons therapy for myofascitis had clinical efficacy, easy to operate, safe, with appropriate application.

Characteristics of Back Muscle Strength in Patients with Scheduled for Lumbar Fusion Surgery due to Symptomatic Lumbar Degenerative Diseases

STUDY DESIGN: Cross sectional study. PURPOSE: To evaluate characteristics of back muscle strength in patients scheduled for lumbar fusion surgery. OVERVIEW OF LITERATURE: Little is known regarding muscle strength in patients with symptomatic lumbar degenerative diseases who require fusion surgery. METHODS: Consecutive 354 patients scheduled for posterior lumbar interbody fusion due to symptomatic degenerative diseases were approached for participation. 316 patients were enrolled. Before surgery, muscle strength was assessed by measuring maximal isometric extension strength at seven angular positions (0degrees, 12degrees, 24degrees, 36degrees, 48degrees, 60degrees, and 72degrees) and mean isometric strength was calculated. The Oswestry Disability Index (0-100) and visual analogue scale (0-100) for back pain were recorded. Muscle strength was compared according to gender, age ( or =70 years) and scheduled fusion level (short, or =3). RESULTS: Isometric strength was significantly decreased compared with previously reported results of healthy individuals, particularly at extension positions (0degrees-48degrees, p0.05). Isometric strengths showed significant, but weak, inverse correlations with age and Oswestry Disability Index (r<0.4, p<0.05). CONCLUSIONS: In patients with symptomatic lumbar degenerative diseases, back muscle strength significantly decreased, particularly at lumbar extension positions, and in females and older patients.

Clinical and Radiological Predictive Factors to be Related with the Degree of Lumbar Back Muscle Degeneration: Difference by Gender

BACKGROUND: The prediction of lumbar back muscle degeneration is important because chronic low back pain and spino-pelvic imbalance have been known to be related to it. However, gender difference should be considered because there are different quality and volume of muscles between genders. The purpose of this study was to search for clinical and radiological factors to predict the degree of lumbar back muscle degeneration according to gender difference. METHODS: We reviewed 112 patients (44 men and 68 women) with spinal stenosis who underwent a decompressive surgery between 1 January 2009 and 31 December 2011. Degrees of lumbar back muscle degeneration were classified into three categories by the fatty infiltration at each L3-4 disc level on the axial view of T1 magnetic resonance imaging (MRI). Age, sex, bone marrow density score, and body mass index (BMI) were obtained from chart reviews. Lumbar lordosis, sacral slope, pelvic tilt (PT), and pelvic incidence were calculated with lumbar spine standing lateral radiographs. The degrees of spinal stenosis and facet arthropathy were checked with MRI. Student t-test, chi-square test, or Fisher exact test were used to compare clinical and radiological parameters between genders. Analysis of variance (ANOVA) and linear regression analysis were used to search for a relationship between lumbar back muscle degeneration and possible predictive factors in each gender group. RESULTS: Many clinical and radiological parameters were different according to gender. The age, BMI, and PT in the female group (p = 0.013, 0.001, and 0.019, respectively) and the PT in the men group (p = 0.018) were predictive factors to be correlated with lumbar back muscle degeneration. CONCLUSIONS: The PT was the important predictive factor for lumbar back muscle degeneration in both, the male and the female group. However, age and BMI were predictive factors in the female group only.

Evaluation of the Back Muscle Exercise for the Lumbar Discectomy Patients

STUDY DESIGN: Retrospective study. OBJECTIVES: To identify the implementation of self-exercise therapy and analyze the effects of exercise therapy after lumbar discectomy. MATERIALS AND METHODS: Studied 47 patients who underwent partial lumbar discectomy and laminectomy from January, 2009 to December, 2009. They were instructed on 16 kinds of exercise therapy in total from postoperative 1day to postoperative 6weeks. Group A (n=25), whose frequency of outpatient clinic visit is above the average, and Group B (n=22), whose frequency of visit is relatively low;, below 5 times. We tested the visual analog scale (VAS scale) of back, Oswestry disability index and the strength of the two groups before surgery and at postoperative 3, 6, and 12 months. RESULTS: The degree of pain was significantly different (26.6+/-9.4 and 53.5+/-18.6) between group A and group B at postoperative 6 months. Function of daily life and strength test were significantly different (6.6+/-4.8 and 11.3+/-4.0 at group A, 3.6+/-0.9 and 3.0+/-1.1 at group B) between the two groups at postoperative 12 months. The characteristics of low compliance patients are low accessibility to the hospital and lack of knowledge on the importance of exercise according to the degree of pain. CONCLUSION: These results suggested that postoperative exercise program has significant effects on the pain, the function of daily life. It also increases flexibility and strengthens the muscle of patients with high compliance of outpatient clinic visit. The factors influencing the results are the age of patients, the willingness to exercise, and the environment in which each patient lives/resides.

Clear Cell Sarcoma of the Upper Thoracic Back Muscle

Clear cell sarcoma (CCS), also called malignant melanoma of soft parts, is a rare malignant soft tissue tumor and is often associated with tendons or aponeuroses. Most of CCS involve extremities, especially lower extremities, but a tumor occurring in the trunk is rare. We report an extremely rare case of CCS originated in the upper thoracic back muscle. To our knowledge, this case is the second report of CCS of the back muscle.

Estudo sobre o efeito da combinação de cargas na determinação do limiar de fadiga eletromiográfi co dos músculos eretores da espinha / Study about the effect of the load combination on the electromyographic fatigue threshold determination of the erector spinae muscle

O objetivo deste estudo foi analisar o efeito da combinação de diferentes percentuais de cargas na determinação do limiar de fadiga eletromiográfi co (EMGLF) dos músculos eretores da espinha (ER). Participaram deste estudo oito voluntários do sexo masculino. Os eletrodos foram posicionados sobre o músculo ER bilateralmente (L1). O voluntário executou contrações isométricas até a exaustão com 30%, 40%, 50% e 60% da contração isométrica voluntária máxima. O EMGLF-C4 é aquele obtido com a utilização das quatro cargas; o EMGLF-C3/4/5, combinando cargas de 30, 40 e 50%; o EMGLF-C3/4/6, combinando cargas de 30, 40 e 60%; o EMGLF-C3/5/6, combinando cargas de 30, 50 e 60%, e o EMGLF-C4/5/6 combinando cargas de 40, 50 e 60%. Para a comparação entre as combinações de carga utilizou-se o teste de Friedman (p<0,05), e para a comparação entre os lados utilizou-se o teste de Wilcoxon (p<0,05). Observou-se que ao comparar o EMGLF-C4 com as outras combinações de cargas, não há diferenças signifi cativas no ER do lado direito, já no ER do lado esquerdo esta semelhança não ocorre somente com o EMGLF-C4/5/6. Concluiu-se que as combinações propostas para determinação do EMGLF apresentam índices semelhantes bilateralmente e que unilateralmente apenas para o lado esquerdo a combinação de cargas entre 40%, 50% e 60% não apresenta semelhança, permitindo com isso otimizar o presente protocolo quanto ao percentual de carga utilizado e o número de percentuais.

The objective of this study was to analyze the effect of load combination on the electromyographic fatigue threshold (EMGFT) of the erector spinae muscle (ES). Eight male subjects have participated of this study. Surface electrodes were attached bilaterally on the ES (L1). The subjects executed isometric contractions with loads of 30%, 40%, 50% and 60% of the maximum voluntary isometric contraction until the exhaustion. The EMGLF-C4 was obtained throughout four loads and then was obtained the EMGLF-C3/4/5, throughout loads of 30, 40 e 50%, the EMGLF-C3/4/6, throughout loads of 30, 40 e 60%, the EMGLF-C3/5/6, throughout loads of 30, 50 e 60%, and the EMGLF-C4/5/6 throughout loads of 40, 50 e 60%. To the comparison among the combinations it was used a Friedman test (p<0,05), and to the comparison between sides it was used a Wilcoxon test (p<0,05). When comparing the EMGLF-C4 with the combinations of loads, there are no signifi cant differences in the ES of the right side, but in the ES of the left side similar results didn’t happened with the EMGLF-C4/5/6. The present study concluded that the ES presented similar indexes bilaterally and that unilaterally just to the left side the combination of loads among 40%, 50% and 60% didn’t present similar results, allowing us to optimize the percent of load and the number of loads of the present protocol.

Application of the cervical back muscle trainer in the cervical back muscle exercise / 中国康复理论与实践

@#ObjectiveTo investigate the effect of a cervical back muscle trainer. MethodsA cervical back muscle trainer designed by ourself was used in 128 patients with different kinds of cervical spondylosis. The situation of pain and activity of daily life of the patients before and 1 month after treatment were recorded and compared. ResultsThe neck pain of all of the patients nearly completely disappeared in a month and their activity of daily life improved significantly(P<0.01). ConclusionThe cervical back muscle trainer can improve the stability of cervical vertebrae through increasing the strength of the cervical back muscle, which can be used as an assistant rehabilitation approach of all kinds of cervical spondylosis.

Effects of the Strengthening Exercise on Back Muscles after Lumbar Discectomy / 대한척추외과학회지

STUDY DESIGN: A retrospective study about lumbar strengthening exercise after lumbar discectomy. OBJECTIVES: To evaluate the effect of lumbar strengthening exercise on muscle power and pain, to analyze the problem of rehabilitation program after lumbar discectomy. SUMMARY OF LITERATURE REVIEW: The effectiveness of Lumbar strengthening exercise is still controversy and we can not found the similar article for this kind problem. MATERIALS AND METHODS: Three-hundred twenty eight patients of microscopic lumbar discectomy from 1998 to 1999, were divided into 2 groups; exercise group was 72 cases among 119 patients, and non-exercise group was 58 cases among 208 patients. degree of pain and functional activity were evaluated by visual analog scale and API test, respectively, at postoperative 3 months, 6 months, 1 year. the reason for not exercising was surveyed in non-exercise group. RESULTS: Exercise group 119 patients(36%). The most common cause of Non-Exercise was a deficiency of importance for lumbar strengthening exercise and exercise was done better in civil peoples than inrural peoples. There was a significant good result in exercise group by visual analog scale for pain at 3 months and 6 months postoperatively, but no difference between two groups after 1 year. exercise group had better results in flexion/extension test and fatigue endurance test. Lumbar strengthening exercise was a good method for relieving the pain in short term, but it was not effective in long term follow up. CONCLUSIONS: These results suggest that good results after lumbar discectomy in exercise group result from the secondary effects of increasing muscle power rather than relieving pain.

Correlation of Ultrasonographic Measure of Lumbar Multifidus Muscles with Isometric Torque of Low Back

OBJECTIVE: To measure lumbar multifidus muscles by ultrasonography and to study its correlation with the isometric peak touque of back. METHOD: Bilateral L5 and S1 multifidus muscle sizes of 18 healthy volunteers were measured in prone position by ultrasonography with 7.5 MHz, 40 mm-length probe. Multifidus muscles were identified using anatomic landmark-spinous process and lamina and vertical and horizontal diameter were measured. Boundary of muscle was traced and cross sectional area was measured. Lumbar spinal range of motion (ROM) and isometric peak torque of three axes-flexion/ extension, rotation and lateral flexion-were measured by Isostation B-200R back muscle tester. RESULTS: Multifidus muscle cross sectional areas were well correlated with isometric peak torque in all direction of movements. Muscle size and lumbar spine ROM showed no correlation. CONCLUSION: Ultrasonographic measure of lumbar multifidus muscles could be a useful tool to estimate back muscle function.

ANALYSIS ON BACK STRENGTH ON GROWING STATE / 体力科学

1) Children's data (10-18 years old) of back strength, height, grip strength and running long jump from data book of Japan Education Ministry (1964-1981) were analyzed. Back strength was mainly studied and was compared with other data (grip strength etc.) . The groups with high average values for back strength at 10-14 years old did not necessarily show high values for back strength at 17 years old, or vice versa. Values for back strength at 10-14 years old were not significantly correlated with those at 17 years old.<BR>2) Using the data from data book mentioned above, tension of deep back muscle (FMUS) was calculated based on kinetic models (FMUS. I, II, III) . Calculated FMUS values were 3-5 times larger than measured back strength values at each age.<BR>3) Relative change of back strength and FMUS in 1964-1981 were compared. All values for back strength were lower than those for FMUS except in 1967. During the late 1960th and the 1970th, average back strength values gradully decreased, but the decrease of FMUS was less obvious than that of back strength.<BR>4) Based on the data of 422 children (7-12 years old, male and femele), values of diaphragm area were approximated with some assumptions, and then FMUS values were calculated. FMUS values calculated by approximate diaphragm area were significantly larger than those calculated by constant diaphragm area (465 cm2) .<BR>The figure for getting FMUS values easily was offered to avoid troublesome calculation. This consists of two graphs, and one can read FMUS values with reasonable precision. Parameters needed for getting FMUS values are sexuality, height, body weight and back strength.