The Technique of Intradiscal Injection: A Narrative Review.

BACKGROUND: Low back pain (LBP) is one of the most common spine diseases and represents the most frequent cause of absence from work in developed countries. Approximately 40% of chronic LBP is related to discogenic origin. The goal of the study is producing a review of literature to describe analytically the techniques of intradiscal injections. METHODS: PubMed database was searched for clinical studies with the different key terms: "intradiscal", "injection", "steroid" "procedures", "techniques", "CT", "MRI", "fluoroscopy", "fluoroscopic", "guidance", "ozone", "ultrasound", "images". Only studies written in English, French, or Italian in which the intradiscal injection represents the main procedure for the low back discopathy treatment on humans were considered. We excluded the articles that do not mention this procedure; those which indicated that the intradiscal injection had happened accidentally during other treatments; those reporting the patient's pain was determined by other causes than the discopathy (facet joint syndrome, tumor, spondylodiscitis). RESULTS: Thirty-one articles dated from 1969 to 2018 met the criteria. The examined population was 6843 subjects, 52.3% male and 47.7% female, with a mean age of 45.9±10.1 years. The techniques are highly variable in terms of procedure: different operators, needle guidance, injection sites, drugs, tilt angle of the needle). CONCLUSION: The efficacy and the safety of the intradiscal procedures are not easily comparable due to different types of studies and their limited number. Further studies are needed to standardize the intradiscal injection technique/procedure to improve safety, repeatability and effectiveness, and last but not least to reduce peri- and postoperative care and health-care costs.

Constraint-induced movement therapy as a rehabilitation intervention for upper extremity in stroke patients: systematic review and meta-analysis.

Constraint-induced movement therapy (CIMT) is a neurorehabilitation technique designed to improve upper extremity motor functions after stroke. This review aimed to investigate evidence of the effect of CIMT on upper extremity in stroke patients and to identify optimal methods to apply CIMT. Four databases (MEDLINE, EMBASE, CINHAL, and PEDro) and reference lists of relevant articles and reviews were searched. Randomized clinical trials that studied the effect of CIMT on upper extremity outcomes in stroke patients compared with other rehabilitative techniques, usual care, or no intervention were included. Methodological quality was assessed using the PEDro score. The following data were extracted for each trial: patients' characteristics, sample size, eligibility criteria, protocols of CIMT and control groups, outcome measurements, and the PEDro score. A total of 38 trials were identified according to the inclusion criteria. The trials included were heterogeneous in CIMT protocols, time since stroke, and duration and frequency of treatment. The pooled meta-analysis of 36 trials found a heterogeneous significant effect of CIMT on upper extremity. There was no significant effect of CIMT at different durations of follow-up. The majority of included articles did not fulfill powered sample size and quality criteria. The effect of CIMT changed in terms of sample size and quality features of the articles included. These meta-analysis findings indicate that evidence for the superiority of CIMT in comparison with other rehabilitative interventions is weak. Information on the optimal dose of CIMT and optimal time to start CIMT is still limited.

Injuries Among Italian DanceSport Athletes: A Questionnaire Survey.

During training and competition, athletic dancers perform complex artistic movements that can lead to stress on the musculoskeletal system, making them subject to high risk of injury. The purpose of this study was to evaluate the prevalence, location, and nature of musculoskeletal injuries among dancesport athletes and to identify potential risk factors for injury. This cross-sectional study was performed at several national dancesport meetings in Italy. All 168 dancesport athletes who participated at the meetings were invited to complete a questionnaire related to injuries they may have suffered during the previous year; other information collected included demographic data (age, sex, height, weight), dance participation (discipline, categories), training (training duration, years since starting to dance), and injury (location, etiology). Of the 168 dancers, 153 completed the questionnaire. Of the 102 injuries reported, 73 athletes (47.7%) reported at least 1 injury. The locations of the injuries were the lower limbs (n=75, 73.5%), upper limbs (8, 7.8%), and spine (19, 18.7%). Significant differences were found in the injury location (p<0.01) as well as the nature of the injury (p<0.01). No significant differences were found between injured and non-injured athletes in demographic data, dance participation, and training variables (p>0.05). The results indicate that about half of the dancers reported at least 1 injury, with these being located particularly in the lower limbs and predominantly strain and sprain injuries. To reduce the prevalence of injuries, a prevention program may be indicated, with future research needed to identify appropriate strategies to prevent injuries.