Do MRI-derived muscle moment-arms in patients with chronic low back pain differ from healthy individuals? A comparative study.

OBJECTIVES: The present study aimed to estimate the trunk muscles moment-arms in low back pain (LBP) patients and compare this data to those of healthy individuals. This research further explored whether the difference of the moment-arms between these two is a contributing factor to LBP. METHODOLOGY: Fifty patients with CLBP (group A) and 25 healthy controls (group B) were enrolled. All participants were subjected to magnetic resonance imaging of lumbar spine. Muscle moment-arms were estimated on a T2W axial section parallel to the disc. RESULTS: There was statistically significant differences (p < 0.05) in the sagittal plane moment-arms at L1-L2 for right erector spinae (ES), bilateral psoas and rectus abdominis (RA), right quadratus lumborum (QL), and left obliques; bilateral ES, QL, RA, and right psoas at L2-L3; bilateral QL, RA, and obliques at L3-L4; bilateral RA and obliques at L4-L5; and bilateral psoas, RA, and obliques at L5-S1. There was no statistically significant difference (p < 0.05) in the coronal plane moment-arms except for left ES and QL at L1-L2; left QL and right RA at L3-L4; right RA and obliques at L4-L5; and bilateral ES and right RA at L5-S1. CONCLUSIONS: There was a significant difference in muscle moment-arms of the lumbar spine's prime stabilizer (psoas) and primary locomotors (rectus abdominis and obliques) between LBP patients and healthy individuals. This difference in the moment-arms leads to altered compressive forces at intervertebral discs and may be one of the risk factors for LBP.

Evaluation of the Correlation of Magnetic Resonance Imaging and Electrodiagnostic Findings in Chronic Low Backache Patients.

BACKGROUND: Low back pain (LBP) is one of the most common medical complaints and leading cause of workforce loss in many countries. Magnetic resonance imaging (MRI) is a highly sensitive method for the detection of lesions in the spine because of its excellent imaging of anatomical detail. However, MRI does not provide information about physiological nerve function and has relatively low specificity. Electrodiagnostic (EDX) study, including needle electromyography (EMG), is a specific test to assess the physiological functions of nerve roots or peripheral nerves. The aim of the present study was to correlate the electrophysiological and MRI findings in chronic low backache patients. MATERIALS AND METHODS: Fifty patients (26 males and 24 females) with mean age 33.54 ± 8.33 years with a history of LBP of minimum 3 consecutive months were evaluated with MRI and EDX (bilateral nerve conduction study of three nerves [tibial, peroneal, and sural nerve] and bilateral EMG of three muscles [paraspinal, tibialis anterior, vastus medialis]) studies. RESULTS: Twenty-seven patients showed disc involvement on MRI and 23 MRI were normal. Mean conduction velocity was mildly decreased in tibial and sural nerves in all the patients either with normal MRI or disc involvement on MRI. In disc involvement conduction velocity, decrease was more as compared to normal MRI. About 39% patients with normal MRI and 78% patients with disc involvement showed abnormal EMG. This data represented statistically significant association of EDX study with MRI (P < 0.05). CONCLUSIONS: In patients with LBP, EDX studies are significantly more correlated with clinical data than MRI. Therefore, EMG may be a useful diagnostic tool to establish management protocols and prevent unnecessary interventions. EDX gives a better representation of physiological status of nerve and muscle, a supra added benefit which MRI lacks. However, MRI gives better visualization of anatomic parameters and structural details which may or may not be associated with chronic LBP.

Spino-pelvic radiological parameters in normal Indian population.

INTRODUCTION: There is increasing emphasis on the sagittal spino-pelvic alignment and its interpretation is of critical importance in the management of spinal disorders. A cross-sectional study of several spino-pelvic radiographic parameters was conducted to determine the physiological values of these parameters, to calculate the variations of these parameters according to epidemiological data, and to study the relationships among these parameters. MATERIAL AND METHOD: Fifty normal healthy volunteers (29 males and 21 females) with no history of back pain were selected and were subjected to standing sagittal spino-pelvic radiographs. All the measurements of various radiographic parameters were performed with use of a software program. A statistical analysis was done to study the relationships among them. RESULTS: The mean values of pelvic incidence (PI) and lumbar Lordosis Angle (LLA) were 48.52 ± 8.99 and 58.78 ± 9.51, respectively. There was statistical difference between male and female parameters in LLA, lumbo-sacral angle (LSA), sacral horizontal angle (SHA), sacral inclination angle (SIA), sacropelvic angle (PRS1), pelvisacral angle (PSA), and PI. A majority of parameters had higher values for female subjects when compared to male subjects. PI was positively correlated with LLA, pelvic angle (PA), pelvic overhang (PO), pelvic tilt (PT), sacrofemoral distance (SFD), SHA, and sacropelvic translation (SPT), which were highly significant, whereas LLA was positively correlated with SHA and SIA only. PI and LLA were both negatively correlated with PSA, pelvic thickness (PTH), and PRS1. CONCLUSIONS: This study presents the various spino-pelvic radiographic parameter values of a sample of the normal asymptomatic Indian population. There was significant difference in radiographic parameters between males and females in about half of the parameters studied in the sample. The values obtained are comparable with the values presented as normal in the literature. A comparison of the study results with data published about other populations revealed no differences in any of the pelvic parameters between the Indian, Brazilian, and Korean populations.

Magnetic resonance imaging of lumbar trunk parameters in chronic low backache patients and healthy population: a comparative study.

PURPOSE: The aim of this study was to evaluate the lumbar trunk parameters by MRI and investigate their association with chronic low backache. METHODS: Fifty patients (26 males and 24 females) with mean age 33.54 ± 8.33 years with a history of low back pain (LBP) of minimum 3 consecutive months constituted the study group (Group A). To match with the study group, 15 normal healthy volunteers (9 males and 6 females) with no history of back pain were selected (Group B). Both the groups were subjected to magnetic resonance imaging of lumbosacral spine and lumbar trunk parameters were calculated. RESULTS: Trunk width, depth and skin angle were comparable at L3-L4, L4-L5 and L5-S1 disc levels; significant difference with regard to disc angle of L3-L4 (p = 0.005) and L4-L5 (p = 0.02) and cross-sectional area (CSA) of disc at L4-L5 level (p = 0.01) was observed between two groups. There was a tendency of smaller CSA of paraspinal and abdominal oblique muscles in Group A patients, but the measurements were not statistically different from Group B patients. Rectus abdominis muscles showed a unique pattern of larger CSA at L3-L4 and L4-L5 disc levels and smaller CSA at L5-S1 in LBP patients. Intervertebral disc degenerative changes on MRI were observed in 27 (54 %) patients in the Group A; and none of the Group B participants showed degenerative changes. CONCLUSIONS: Tendency of smaller trunk musculature CSA may be a cause or a result of chronic LBP. A unique pattern of larger CSA at L3-L4 and L4-L5 disc levels and smaller CSA at L5-S1 of Rectus abdominis muscles is observed in LBP patients compared to healthy persons. Differences in disc angles and CSA of disc at L3-L4 and L4-L5 levels between the two groups signify that these may be the predisposing factors leading to LBP due to abnormal load/stress transmission and precipitating early degenerative changes in the disc.

Diagnostic Utility of Conventional Radiography in Head Injury.

BACKGROUND: Head injury is the frequent cause of morbidity and mortality and frequently encountered in emergency department. Radiological examination of the skull is an indispensable part in the management of patients suffering from head trauma. AIM: To determine the accuracy of X-ray in detecting skull fractures, comparing the same with autopsy and CT evaluation. MATERIALS AND METHODS: The medico-legal cases that died of traumatic head injury and brought for autopsy over a period of two years were included in the study. Only those cases were selected who had underwent both X-ray and CT evaluation prior to death. RESULTS: When compared with autopsy, X-ray missed 19.1% of fractures while 11.9% fractures missed in contrast to CT scan. CONCLUSION: Skull X-ray is of little benefit when a CT scan is obtained. It has no added advantage over CT scan. Whenever there is facility of CT scan is available, the patient of head injury should not underwent X-ray as it can only delay the diagnosis of an associated intracranial injury and exposes the already traumatised patient to harmful radiations.