ABSTRACT
Significant changes in disk biochemistry were evident in the nuclei pulposi of 25 symptomatic disks that demonstrated abnormal diskography. Compared with the results from ten normal disk from young subjects (mean age, ten years) and from ten asymptomatic disks from adult patients (mean age, 33 years), the symptomatic disks demonstrated significantly greater collagen content than the young and asymptomatic adult subjects, respectively. Significantly fewer total glycosaminoglycans (GAGs) and significantly less water content were also evident for the diseased disks. The mean pH of the nucleus pulposus from 23 patients was also significantly reduced for the symptomatic disks as compared with the mean pH measured for four asymptomatic adult subjects. Although significantly fewer total GAGs were observed for the symptomatic disks, there were no significant differences in the percent composition of hyaluronic acid (HA), chondroitin sulfate (CS), or keratan sulfate (KS) among the normal and symptomatic disks. Significant changes in disk biochemistry are associated with the symptomatic disk, and these changes could contribute to the development of the painful disk syndrome.
Subject(s)
Intervertebral Disc Displacement/metabolism , Intervertebral Disc/chemistry , Lumbar Vertebrae , Adult , Body Water , Child , Collagen/analysis , Glycosaminoglycans/analysis , Humans , Hydrogen-Ion Concentration , Intervertebral Disc Displacement/surgery , Spinal FusionABSTRACT
Methods for detecting recruitment patterns of the lumbar muscles during exercise in patients with chronic low back pain are limited. This article discusses the use of magnetic resonance imaging with Roman chair extension exercise to examine lumbar muscle usage in five normal volunteers, five chronic low back pain patients without surgery, and five chronic low back pain patients with surgery. Changes in signal intensities of psoas, multifidus, and longissimus/iliocostalis with graded exercise were measured at three lumbar disc levels. At rest, there was a difference between multifidus and longissimus/iliocostalis signal intensity in chronic low back pain subjects without surgery (P = 0.0162) and in chronic low back pain subjects with surgery (P = 0.0036), but not in normal subjects. At peak exercise, there was a difference in signal intensities between multifidus and longissimus/iliocostalis in all groups (normal volunteers, P = 0.0069; chronic low back pain patients without surgery, P = 0.0125; chronic low back pain patients with surgery, P = 0.0060). The exercise response was attenuated in chronic low back pain patients with surgery. Thus, MRI demonstrates static and dynamic differences in lumbar paraspinal musculature in chronic low back pain subjects compared to normal subjects.
Subject(s)
Exercise/physiology , Low Back Pain/physiopathology , Lumbar Vertebrae , Muscles/physiopathology , Humans , Low Back Pain/surgery , Magnetic Resonance Imaging , Male , Muscles/diagnostic imaging , RadiographyABSTRACT
Acute peritendinitis calcarea, adhesive capsulitis, and anterior acromion impingement syndrome are common problems of the shoulder. Needle and drug therapy are indicated to relieve pain in the treatment of acute cases, with a regular home program of exercise essential for successful results in all cases. Surgery is recommended only if the nonoperative approach is unsuccessful.
