Rider sitting position widens lumbar intervertebral distance: a prospective observational study

Abstract Background: Reduced lumbar lordosis may make the process of identifying the intervertebral distance easier. The primary aim of this study was to measure the L3-L4 intervertebral space in the same patients undergoing spinal anesthesia in three different sitting positions, including the classic sitting position (CSP), hamstring stretch position (HSP) and rider sitting position (RSP). The secondary aim was to compare ultrasonographic measurements of the depth of the ligamentum flavum and intrathecal space in these three defined positions. Methods: This study is a single-blinded, prospective, randomized study. Ninety patients were included in final analysis. the patients were positioned on the operating table in three different positions to perform ultrasonographic measurements of the spinal canal. The intervertebral distance (IVD), the distance between the skin and the ligamentum flavum (DBSLF) and the intrathecal space (IS) were measured in the L3 -L4 intervertebral space in three different positions. Results: The RSP produced the largest mean distance between the spinous processes. The RSP yielded a significantly larger IVD than did the CSP (p < 0.001) and HSP (p < 0.001). The DBSP was larger in the CSP than in the HSP (p = 0.001). The DBSLF was significantly larger in the RSP than in the HSP (p = 0.009). Conclusions: Positioning the patient in the RSP significantly increased the intervertebral distance between L3 -L4 vertebrae compared to the CSP and HSP, suggesting easier performance of lumbar neuraxial block.

Relationship of the skin and subcutaneous tissue thickness in the tensiomyography response: a novel ultrasound observational study

SUMMARY BACKGROUND: The aim of the study was to describe and correlate the skin, subcutaneous tissue, and superficial fascia thickness assessed by ultrasonography (US) with the lumbar erector spinae muscles contractile properties evaluated by tensiomyography (TMG). METHODS: A cross-sectional descriptive study with 50 healthy participants was performed. The point of maximum lordosis in the lumbar region of the right erector spinae was evaluated by US and TMG. First, the skin, subcutaneous tissue, and superficial fascia thicknesses (cm) were assessed by US. Second, the five contractile TMG parameters were analyzed from the right erector spinae muscles belly displacement-time curves: maximal radial displacement (Dm), contraction time (Tc), sustain time (Ts), delay time (Td), and half-relaxation time (Tr). Finally, correlation analyses using Pearson (r for parametric data) and Spearman (rs for non-parametric data) coefficients were performed. RESULTS: A strong negative correlation was shown between Dm and subcutaneous tissue thickness (rs=-0.668; P<.001). Furthermore, moderate negative correlations were observed between Dm and skin thickness (r=-0.329; P=0.020) as well as Tr and subcutaneous tissue thickness (rs=-0.369; P=0.008). The rest of the parameters did not show statistically significant correlations (P >.05). CONCLUSION: Therefore, the lumbar erector spinae contractile properties during TMG assessments, especially Dm and Tr, may be widely correlated by the skin and subcutaneous tissue thickness.

RESUMO CONTEXTO: O estudo foi elaborado para descrever e correlacionar a pele, o tecido subcutâneo e a espessura da fascia superficial avaliados pelo ultrassom (EUA) com as propriedades contráteis do músculo eretor da coluna lombar avaliadas por tensiomiografia (TMG). MÉTODOS: Foi realizado um estudo descritivo transversal com 50 participantes saudáveis. O ponto de lordose máxima na região lombar da coluna ereta direita foi avaliado pelos EUA e TMG. Primeiro, a pele, o tecido subcutâneo e as espessuras da fáscia superficial (cm) foram avaliadas pelos EUA. Em segundo lugar, os cinco parâmetros TMG contráteis foram analisados a partir das curvas de deslocamento-tempo da barriga do músculo eretor da espinha direita: deslocamento radial máximo (Dm), tempo de contração (Tc), tempo de sustentação (Ts), tempo de atraso (Td) e meio tempo de relaxamento (Tr). Finalmente, foram realizadas análises de correlação usando os coeficientes Pearson (r para dados paramétricos) e Spearman (rs para dados não paramétricos). RESULTADOS: Uma correlação forte negativa foi mostrada entre Dm e espessura subcutânea do tecido (rs = −0,668; P < 0,001). Além disso, foram observadas correlações moderadas negativas entre Dm e espessura da pele (r = −0,329; P = 0,020), bem como a espessura subcutânea do tecido (rs = −0,369; P = 0,008). O restante dos parâmetros não mostrou correlações estatisticamente significativas (P > 0,05). CONCLUSÃO: Portanto, as propriedades contráteis do eretor da espinha lombar durante as avaliações TMG, especialmente Dm e Tr, podem ser amplamente correlacionadas com a pele e a espessura subcutânea do tecido.

Interobserver reproducibility of radiographic evaluation of lumbar spine instability / Reprodutibilidade interobservadores da avaliação radiográfica de instabilidade em coluna lombar

ABSTRACT Objective: To measure the interobserver reproducibility of the radiographic evaluation of lumbar spine instability. Methods: Measurements of the dynamic radiographs of the lumbar spine in lateral view were performed, evaluating the anterior translation and the angulation among the vertebral bodies. The tests were evaluated at workstations of the organization, through the Carestream Health Vue RIS (PACS), version 11.0.12.14 Inc. 2009© system. Results: Agreement in detecting cases of radiographic instability among the observers varied from 88.1 to 94.4%, and the agreement coefficients AC1 were all above 0.8, indicating excellent agreement. Conclusion: The interobserver analysis performed among orthopedic surgeons with different levels of training in dynamic radiographs of the spine obtained high reproducibility and agreement. However, some factors, such as the manual method of measurement and the presence of vertebral osteophytes, might have generated a few less accurate results in this comparative evaluation of measurements.

RESUMO Objetivo: Mensurar a reprodutibilidade interobservadores da avaliação radiográfica da instabilidade da coluna lombar. Métodos: Foram realizadas mensurações das radiografias dinâmicas de coluna lombar na incidência em perfil, avaliando-se a translação anterior e a angulação entre os corpos vertebrais. Os exames foram avaliados em workstations da própria instituição, por meio do sistema Vue RIS (PACS) da Carestream Health, versão 11.0.12.14 Inc. 2009©. Resultados: A proporção de concordância em detecção de casos de instabilidade radiográfica entre os observadores variou de 88,1 a 94,4%, e os coeficientes de concordância AC1 estiveram todos acima de 0,8, indicando concordância excelente. Conclusão: A análise interobservadores realizada entre médicos ortopedistas com diferentes níveis de treinamento em radiografias dinâmicas da coluna vertebral obteve elevada reprodutibilidade e concordância. No entanto, alguns fatores, como método manual de aferição e a presença de osteófitos vertebrais, podem ter gerado alguns resultados menos consistentes nessa avaliação comparativa de medidas.

Utilidad de la resonancia magnética en el diagnóstico de lesiones musculares de localización atípica / Usefulness of magnetic resonance imaging in the diagnosis of atypical location muscle lesions

En el presente los desgarros musculares son una causa muy frecuente de lesión en la práctica deportiva. Según los estudios actuales, un 30% de las lesiones en atletas afecta los músculos, siendo particularmente comunes a nivel de los isquiotibiales, el recto anterior de los cuádriceps, los gemelos y los aductores. El diagnóstico se realiza en forma sencilla mediante un estudio ecográfico. Sin embargo, existe un número importante de lesiones musculares de localización profunda e infrecuente, que pueden pasar inadvertidas en la ecografía y que causan largos períodos de inactividad para el deportista. La resonancia magnética (RM), por su resolución anatómica y capacidad multiplanar, es el método de elección para el estudio de este tipo de afecciones, ya que permite descartar otras patologías de similar presentación clínica y realizar un diagnóstico específico. En este artículo describimos los desgarros musculares de localización inusual, particularmente los de localización pelviana, evaluando también la pared torácica, abdominal y miembros superiores e inferiores. En todos los casos, se usaron equipos de alto campo 1.5 y 3 Tesla.

Muscle injuries are currently particularly frequent among people who participate in sports. Current studies show that 30% of injuries in athletes affect muscles, with hamstrings, quadriceps, gastrocnemius, and adductors being particularly prevalent. The diagnosis is easily made with an ultrasound study. However, there are a significant number of muscle injuries, considered uncommon, that may be not be detected by ultrasound, mainly because of their depth, and could be responsible for long periods of inactivity for the sportsman. Magnetic resonance imaging (MRI), with a better anatomical resolution and multiplanar capability, is the method of choice for detecting the precise location and severity of the injury and can establish their severity. The aim of this article is to review muscle tears of unusual location, particularly in the pelvic area, but also evaluating the chest wall, abdomen, and upper and lower limbs. All patients were evaluated by 3 and 1.5 Tesla MRI units.

Estudo radiográfico da articulação lombossacra em cães das raças Pastor Alemão, Rottweiler e Doberman / Radiographic study of the lumbosacral joint in German Shepherd, Rottweiler and Doberman dogs

Este trabalho teve como objetivo avaliar a variação entre diferentes raças das medidas radiográficas da articulação lombossacra. Foram utilizados 20 cães da raça Pastor Alemão, 20 cães da raça Rottweiler e 20 da raça Doberman. A articulação lombossacra foi avaliada radiograficamente com os membros pélvicos em posição neutra (N), em ventroflexão (VF) e dorsoextensão (DE). Foram mensurados os ângulos entre os processos articulares de L7 e S1 (PA), entre as epífises distal de L7 e proximal de S1 (EPIF), o ângulo lombossacro (LS), a amplitude de movimento (ROM) desses ângulos, o ponto de interseção das retas que formam esses ângulos e a respectiva ROM. Os resultados mostraram que a altura do canal vertebral em L7 é menor no Pastor Alemão (9,5mm) e maior no Rottweiler (10,5mm). O EPIF-DE foi maior no Pastor Alemão (38,03º). O PA-N foi menor no Pastor Alemão (15,98º). O LS-VF foi menor no Doberman (170,01º), e não diferiu entre o Pastor Alemão (179,17º) e o Rottweiler (176,61º). Os cães Pastores Alemães demonstraram uma maior ROM dos ângulos EPIF e LS. Concluiu-se que cães da raça Pastor Alemão apresentam maior instabilidade dessa articulação em relação às outras duas raças estudadas.(AU)

The purpose of this work was to evaluate the racial difference of radiographic measurements of canine lumbosacral joints.20 German Shepherd, 20 Rottweiler and 20 Doberman dogs were used in the study. The lumbosacral joint was assessed radiographically with the hind limbs in neutral position (N), in ventral flexion (VF) and dorsal extension (DE). We measured the angles between the L7 and S1 articular processes (PA), between the distal L7 and S1 proximal epiphysis (EPIF), the lumbosacral angle (LS), range of motion (ROM) of these angles, the intersection point of the lines that form these angles and their ROM. The results show that the height of the spinal canal in L7 is lower in German Shepherds (9.5mm) than in Dobermans (10mm) and Rottweilers (10.5 mm). The EPIF-DE was higher in the German Shepherd (38.03°). The PA-N was lower in German Shepherd (15.98 °). The LS-VF was lower in the Doberman (170.01°), and LS did not differ statistically between German Shepherd (179.17°) and Rottweiler (176.61°). The ROM of the LS and EPIF angles were greater in the German Shepherd dogs. It was concluded that the German Shepherd dogs have radiographic measurements that lead to greater instability of the lumbosacral joint.(AU)

Fluoroscopy-Guided Lumbar Drainage of Cerebrospinal Fluid for Patients in Whom a Blind Beside Approach Is Difficult

OBJECTIVE: To evaluate the rates of technical success, clinical success, and complications of fluoroscopy-guided lumbar cerebrospinal fluid drainage. MATERIALS AND METHODS: This retrospective study was approved by the Institutional Review Board of our hospital, and informed consent was waived. Ninety-six procedures on 60 consecutive patients performed July 2008 to December 2013 were evaluated. The patients were referred for the fluoroscopy-guided procedure due to failed attempts at a bedside approach, a history of lumbar surgery, difficulty cooperating, or obesity. Fluoroscopy-guided lumbar drainage procedures were performed in the lateral decubitus position with a midline puncture of L3/4 in the interspinous space. The catheter tip was positioned at the T12/L1 level, and the catheter was visualized on contrast agent-aided fluoroscopy. A standard angiography system with a rotatable C-arm was used. The definitions of technical success, clinical success, and complications were defined prior to the study. RESULTS: The technical and clinical success rates were 99.0% (95/96) and 89.6% (86/96), respectively. The mean hospital stay for an external lumbar drain was 4.84 days. Nine cases of minor complications and eight major complications were observed, including seven cases of meningitis, and one retained catheter requiring surgical removal. CONCLUSION: Fluoroscopy-guided external lumbar drainage is a technically reliable procedure in difficult patients with failed attempts at a bedside procedure, history of lumbar surgery, difficulties in cooperation, or obesity.

Methionine synthase reductase polymorphisms are associated with serum osteocalcin levels in postmenopausal women

Homocysteine (Hcy) is thought to play an important role in the development of osteoporosis and fracture. Methionine synthase reductase (MTRR) is an enzyme involved in the conversion of Hcy to methionine. We hypothesized that certain genetic polymorphisms of MTRR leading to reduced enzyme activity may cause hyperhomocysteinemia and affect bone metabolism. We therefore examined the associations of the A66G and C524T polymorphisms of the MTRR gene with bone mineral density (BMD) and serum osteocalcin levels in postmenopausal women. Although we did not detect any significant associations between MTRR polymorphisms and BMD or serum osteocalcin levels, we found that the 66G/524C haplotype, which has reduced enzyme activity, was significantly associated with serum osteocalcin levels in a gene-dose dependent manner (P=0.002). That is, the highest osteocalcin levels (34.5+/-16.8 ng/ml) were observed in subjects bearing two copies, intermediate osteocalcin levels (32.6+/-14.4 ng/ml) were observed in subjects bearing one copy, and the lowest levels of osteocalcin (28.8+/-10.9 ng/ml) were observed in subjects bearing no copies. These results suggest that the 66G/524C haplotype of the MTRR gene affect bone turn over rate.

Musculoskeletal profile due to obesity and risk factors

This study was designed to estimate musculoskeletal complication due to obesity and which of them is directly related to it. This study was carried out on fifty [50] obese female patients, after exclusion of diabetes mellitus, liver and kidney disease. Twenty [20] normal weight by BMI assessment and age matched female as a control. All persons were fulfilled for: 1- Full history and complete clinical examination and locomotor estimation, 2- CBP, 3- ESR, 4- Serum RF, 5- Serum uric acid, 6- Lipid profile [blood cholesterol, triglycerides, LDL and HDL], 7- Plain X-ray of lumbosecral, knee and heels, 8- EMG and nerve conduction study of median, Ulner, common pronial and medial poplitial nerves for the patients complaining of numbnes. [66%] of patients had oestioarthritis of the knee, twenty of them had pattelofemoral OA [40%], [56%] of patients had back pain due to muscle strain, [36%] of patients had planter fasciitis, [8%] of patients had carpal tunnel syndrome, [4%] of patients had fibromyalgia syndrome. There was a significant correlation between the musculoskeletal problems and BMI of patients. All laboratories parameters are within normal range except the lipid profile, which were high in 32 patients and had the significant correlation with musculoskeletal problems. OA of knees, LBP, Planter fasciitis, CT syndrome and Fibromyalgia syndrome are the most common musculoskeletal complications of obesity. The high level of lipid profile in blood may be due to obesity per sea or disability due to musculoskeletal problems and leads to serious cardiovascular and heart complications

Role of CT in inflammatory lesions of lumbo sacral spine

Ten cases of pyogenic and tuberculous osteomyelitis of the lumbo sacral spine were included in this work [5 cases as T.B. osteomyelitis and 5 cases as pyogenic osteomyelitis]. CT appearance of the inflammatory changes of the spine was studied. The diagnostic yieId of CT and conventional plain radiography was compared. The place of CT in diagnostic of the site and extension of the inflammatory process into the epidural and paraspinal regaions was attempted