[Translated article] Frequency of use of discography findings for the diagnosis of low back pain of discogenic origin. Systematic review of the literature.

INTRODUCTION: There are different techniques and interpretations of discography findings to determine it positive for the diagnosis of discogenic pain. This study aims to evaluate the frequency of use of discography findings for the diagnosis of low back pain of discogenic origin. MATERIAL AND METHODS: A systematic review of the literature of the last 17 years was performed in MEDLINE and BIREME. A total of 625 articles were identified, 555 were excluded for duplicates, title and abstract. We obtained 70 full texts of which 36 were included in the analysis after excluding 34 for not meeting the inclusion criteria. RESULTS: Among the criteria in discography to determine it as positive, 8 studies used only the pain response to the procedure, 28 studies used more than one criterion during discography to consider it as positive, the evaluation of at least one adjacent intervertebral disc with a negative result was necessary in 26 studies to consider a discography as positive. Five studies formally expressed the use of the technique described by SIS/IASP to determine a discography as positive. CONCLUSIONS: Pain in response to contrast medium injection, assessed with the visual analogue pain scale ≥6, was the most used criterion in the studies included in this review. Although there are already criteria to determine a discography as positive, the use of different techniques and interpretations of discography findings to determine a positive discography for low back pain of discogenic origin persists.

Diagnostic accuracy of lumbar CT and MRI in the evaluation of chronic low back pain without red flag symptoms.

BACKGROUND: Low back pain (LBP) is one of the most frequent reasons for medical consultation. Most of the patients will have nonspecific LBP, which usually are self-limited episodes. It is unclear which of the diagnostic imaging pathways is most effective and costeffective and how the imaging impacts on patient treatment. Imaging techniques are usually indicated if symptoms remain after 6 weeks. Magnetic resonance imaging (MRI) is the diagnostic imaging examination of choice in lumbar spine evaluation of low back pain; however, availability of MRI is limited. OBJECTIVES: To evaluate the diagnostic accuracy of computed tomography (CT) with MRI (as standard of reference) in the evaluation of chronic low back pain (LBP) without red flags symptoms. To compare the results obtained by two radiologists with different grades of experience. MATERIALS AND METHODS: Patients with chronic low back pain without red flags symptoms were retrospectively reviewed by two observers with different level of experience. Patients included had undergone a lumbar or abdominal CT and an MRI within a year. Once the radiological information was collected, it was then statistically reviewed. The aim of the statistical analysis is to identify the equivalence between both diagnostic techniques. To this end, sensitivity, specificity and validity index were calculated. In addition, intra and inter-observer reliability were measured by Cohen's kappa values and also using the McNemar test. RESULTS: 340 lumbar levels were evaluated from 68 adult patients with chronic low back pain or sciatica. 63.2% of them were women, with an average age of 60.3 years (SD 14.7). CT shows high values of sensitivity and specificity (>80%) in most of the items evaluated, but sensitivity was low for the evaluation of density of the disc (40%) and for the detection of disc herniation (55%). Moreover, agreement between MRI and CT in most of these items was substantial or almost perfect (Cohen's kappa-coefficient > 0'8), excluding Modic changes (kappa = 0.497), degenerative changes (kappa0.688), signal of the disc (kappa = 0.327) and disc herniation (kappa = 0.639). Finally, agreement between both observers is mostly high (kappa > 0.8). Foraminal stenosis, canal stenosis and the grade of the canal stenosis were overdiagnosed by the inexperienced observer in the evaluation of CT images. CONCLUSIONS AND SIGNIFICANCE: CT is as sensitive as lumbar MRI in the evaluation of most of the items analysed, excluding Modic changes, degenerative changes, signal of the disc and disc herniation. In addition, these results are obtained regardless the experience of the radiologist. The rising use of diagnostic medical imaging and the improvement of image quality brings the opportunity of making a second look of abdominal CT in search of causes of LBP. Thereby, inappropriate medical imaging could be avoided (2). In addition, it would allow to reduce MRI waiting list and prioritize other patients with more severe pathology than LBP.

Factores asociados a dolor lumbar en trabajadores sanitarios de un hospital de referencia del Perú

Introducción: El dolor lumbar es una condición inevitable en todo el personal del rubro de la salud, con llevando desde malestar físico hasta una incapacidad funcional del individuo. Objetivo: Determinar los factores asociados a dolor lumbar entre los trabajadores sanitarios en un hospital de referencia del Perú. Metodología: El presente estudio es observacional, analítico, de corte transversal, temporalmente prospectivo, con muestreo no probabilístico. La población estuvo conformada por trabajadores sanitarios del Hospital Santa Rosa de Pueblo Libre durante el periodo de junio a diciembre del año 2022. Resultados: El análisis multivariado determinó que el ser hombre (OR: 2.818, p valor: 0.017), tener sobrepeso (OR:1.782, p valor: 0.013), demanda laboral alta (OR: 4.750, p valor: 0.026), realizar actividad física (OR: 3.610, p valor: 0.031) y tener antecedentes de trauma lumbar (OR: 2.423, p valor: 0.034), fueron factores estadísticamente significativos que se asociaron al dolor lumbar. Discusión: Se pudo observar que, los factores asociados a dolor lumbar fueron el sexo masculino, el sobrepeso, la demanda laboral alta, el realizar actividad física y el antecedente de trauma lumbar. Conocer estas variables permitirá realizar esquemas y charlas preventivas para afrontar esta recurrente patología.

Introduction: Low back pain is an unavoidable condition in all health personnel, ranging from physical discomfort to functional disability of the individual. Objective: To determine the factors associated with low back pain among health workers at a reference hospital in Peru. Methods: This study is observational, analytical, cross-sectional, temporally prospective, with non-probabilistic sampling. The population was made up of health workers from the Hospital Santa Rosa de Pueblo Libre during the period from June to December of the year 2022. Results: The multivariate analysis determined that being a man (OR: 2.818, p value: 0.017), being overweight (OR:1.782, p value: 0.013), high labor demand (OR: 4.750, p value: 0.026), performing physical (OR: 3.610, p value: 0.031) and having a history of low back trauma (OR: 2.423, p value: 0.034) were statistically significant factors associated with low back pain. Discussion: It was possible to observe that the factors associated with low back pain were the male sex, being overweight, high work demand, physical activity and a history of low back trauma. Knowing these variables will make it possible to carry out preventive schemes and talks to deal with this recurring pathology.

[Treatment of patients with chronic nonspecific lumbalgia with various pain triggers]. / Lechenie patsientok s khronicheskoi nespetsificheskoi lyumbalgiei, svyazannoi s razlichnymi bolevymi triggerami.

OBJECTIVE: To evaluate the effectiveness of complex therapy in patients with chronic nonspecific lumbalgia associated with various pain triggers. MATERIAL AND METHODS: There were 121 patients with chronic nonspecific lumbalgia (average duration of pain 8.0±5.0 months) aged 22 to 59 years (average age 42.1±10.5). The lesion of the facet joints (24.8%), sacroiliac joint (23.2%), muscles (16.5%) or their combined lesion (35.5%) was established as pain triggers of lumbalgia. The patients underwent complex therapy, including medications, kinesiotherapy and cognitive therapy. Before and after the course of therapy (on average 3 weeks), a digital rating scale for pain assessment, the Oswestry Disability Index and the Hospital Anxiety and Depression Scale (HADS) were used. RESULTS: After treatment, there was a significant (p<0.01) decrease in pain (6.1±1.1 to 1.13±0.37 points, p<0.01), disability (40.09±3.56 to 22.15±13.20%), anxiety (8.98±0.50 to 6.46±0.34 points) and depression (8.72±0.17 to 6.02±0.26 points). A significant improvement in the condition was found in all pain triggers of chronic lumbalgia. The duration of chronic lumbalgia, the severity of life limitations on the Oswestry Disability Index and anxiety on HADS were the reliable predictors of the low effectiveness of complex therapy. CONCLUSION: Complex therapy, including medications, kinesiotherapy and cognitive therapy, is effective for various pain triggers of chronic lumbalgia.

Frequency of use of discography findings for the diagnosis of low back pain of discogenic origin. Systematic review of the literature. / Frecuencia de uso de los hallazgos de la discografía para el diagnóstico del dolor lumbar de origen discogénico. Revisión sistemática de la literatura.

INTRODUCTION: There are different techniques and interpretations of discography findings to determine it positive for the diagnosis of discogenic pain. This study aims to evaluate the frequency of use of discography findings for the diagnosis of low back pain of discogenic origin. MATERIAL AND METHODS: A systematic review of the literature of the last 17 years was performed in MEDLINE and BIREME. A total of 625 articles were identified, 555 were excluded for duplicates, title and abstract. We obtained 70 full texts of which 36 were included in the analysis after excluding 34 for not meeting the inclusion criteria. RESULTS: Among the criteria in discography to determine it as positive, 8 studies used only the pain response to the procedure, 28 studies used more than one criterion during discography to consider it as positive, the evaluation of at least one adjacent intervertebral disc with a negative result was necessary in 26 studies to consider a discography as positive. Five studies formally expressed the use of the technique described by SIS/IASP to determine a discography as positive. CONCLUSIONS: Pain in response to contrast medium injection, assessed with the visual analog pain scale≥6, was the most used criterion in the studies included in this review. Although there are already criteria to determine a discography as positive, the use of different techniques and interpretations of discography findings to determine a positive discography for low back pain of discogenic origin persists.

Assistência de Enfermagem a pacientes com dor lombar / Nursing care for patients with low back pain: a scope review / Cuidados de enfermería para pacientes con lumbalgia: una revisión de alcance

Objetivo: identificar na literatura e descrever a assistência prestada por enfermeiros a pacientes com dor lombar. Método: revisão de escopo, segundo método Joanna Briggs Institute (JBI) e recomendações Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR). Foi utilizada a estratégia de pesquisa População-Conceito-Contexto para compor a questão de pesquisa. Foram incluídos artigos de seis bases de dados indexadas, sem limite de tempo, nos idiomas português, inglês e espanhol. Resultados: obtiveram-se 1.025 artigos com a busca nas bases de dados, sendo selecionadas 23 publicações para análise após a aplicação dos critérios de exclusão. As informações foram categorizadas em histórico e avaliação do paciente, intervenções invasivas e não invasivas e educação em saúde. Conclusões: há prevalência de intervenções não farmacológicas e práticas educativas no acompanhamento do enfermeiro ao paciente com dor lombar. O sucesso no cuidado é reforçado pela capacidade do profissional em sistematizar a assistência prestada.(AU)

Objective: to identify in the literature and describe the assistance provided by nurses to patients with low back pain. Method: scope review, according to the Joanna Briggs Institute (JBI) method and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) recommendations. The research strategy Population-Concept-Context was used to compose the research question. Articles from six indexed databases were included, with no time limit, in Portuguese, English and Spanish. Results: 1,025 articles were obtained after searching the databases, with 23 publications selected for analysis after applying the exclusion criteria. Information was categorized into patient history and assessment, invasive and non-invasive interventions, and health education. Conclusions: there is a prevalence of non-pharmacological interventions and educational practices in nurses' monitoring of patients with low back pain. Success in care is reinforced by the professional's ability to systematize the assistance provided.(AU)

Objetivo: identificar en la bibliografía y describir la asistencia prestada por enfermeras a pacientes con lumbalgia. Método: revisión del alcance, según el método del Instituto Joanna Briggs (JBI) y las recomendaciones Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR). Se utilizó la estrategia Población-Concepto-Contexto para componer la pregunta de investigación. Se incluyeron artículos de seis bases de datos indexadas, sin límite de tiempo, en los idiomas portugués, inglés y español. Resultados: se obtuvieron 1025 artículos con la búsqueda en las bases de datos y 23 publicaciones para análisis después de aplicar los criterios de exclusión. La información fue categorizada en historia y evaluación del paciente, intervenciones invasivas y no invasivas y educación para la salud. Conclusiones: Existe una prevalencia de intervenciones no farmacológicas y prácticas educativas en los cuidados de enfermería a pacientes con lumbalgia. El éxito en la atención se ve reforzado por la capacidad del profesional para sistematizar la asistencia prestada.(AU)

Psychosocial factors associated with disability in patients with non-specific chronic low back pain: A cross-sectional study.

INTRODUCTION AND OBJECTIVES: Chronic low back pain is the main cause of disability worldwide, generating high costs for society. To evaluate the prevalence of disability in patients with non-specific chronic low back pain and associated factors, including the impacts of low back pain and psychosocial factors linked to kinesiophobia, catastrophism, anxiety, and depression. PATIENTS: A cross-sectional study was carried out with 108 adult individuals who had non-specific chronic low back pain. The patients answered previously validated questionnaires, namely the Brief Pain Inventory, the Roland-Morris Disability Questionnaire, the Pain Catastrophizing Scale, the Tampa Kinesiophobia Scale, and the Hospital Anxiety and Depression Scale. RESULTS: The prevalence of disability observed was 65.7%, with the mean disability score being 15.7±5.3 points in the Roland-Morris Disability Questionnaire. Although pain intensity and other domains of the Brief Pain Inventory, like anxiety, depression, and severe kinesiophobia were significant in the bivariate analyses, they were not associated with disability in the multivariate analysis. Only catastrophic thoughts (prevalence ratio [PR]=1.19; 95% confidence interval [CI]: 1.07-1.32), and the 'walking' domain (PR=1.08; 95% CI: 1.03-1.14) remained statistically associated with disability. CONCLUSION: Pain catastrophization and impact on gait were associated with disability in individuals with non-specific chronic low back pain. Motor control thoughts and behaviors during functional activities were considered to be relevant aspects for the better assessment and treatment of these patients.

Analysis of musculoskeletal disorders-associated disability in Mexico from 1990 to 2021.

BACKGROUND: Musculoskeletal disorders (MSD) affect 1.71 billion people worldwide and are the leading cause of disability. OBJECTIVE: To analyze the years lived with disability (YLD) attributed to MSD in Mexico between 1990 and 2021. MATERIAL AND METHODS: With estimates from the Global Burden of Disease 2021 study, the YLDs due to MSD and their six categories were analyzed, including osteoarthritis, rheumatoid arthritis, gout, neck pain, low back pain, as well as other MSDs. Patterns and trends in the number, crude rate, and YLD age-standardized rate were evaluated at the national and state levels, as well as by age group and gender. RESULTS: MSDs were the main cause of YLDs in Mexico between 1990 and 2021, with an increase of 57.3%, going from 1,458.4 to 2,293.7 per 100,000 population. Low back pain (840.6 YLD) showed the highest rate in 2021, while osteoarthritis had the largest increase. MSDs increased with age and, and except for gout, affected women more often. CONCLUSIONS: From 1990 to 2021, MSDs were the main cause of YLDs in Mexico, with a higher impact on adults and women. MSDs can appear early in life, hence the need for continuous interventions in order to preserve quality of life.

ANTECEDENTES: Los trastornos musculoesqueléticos (TME) afectan a 1710 millones de personas en todo el mundo y es la principal causa de discapacidad. OBJETIVO: Analizar los años vividos con discapacidad (AVD) por TME en México entre 1990 y 2021. MATERIAL Y MÉTODOS: Con las estimaciones del estudio de la Carga Global de la Enfermedad 2021 se analizaron los AVD por TME y sus seis categorías: osteoartritis, artritis reumatoide, gota, dolor cervical, lumbalgia y otros TME. Se evaluaron patrones y tendencias del número, tasa cruda y tasa estandarizada por edad de los AVD a nivel nacional, estatal, por grupos de edad y sexo. RESULTADOS: Los TME constituyeron la principal causa de AVD en México entre 1990 y 2021, con un incremento de 57.3 %; pasaron de 1458.4 a 2293.7 por 100 000 habitantes. La lumbalgia (840.6 AVD) destacó con la mayor tasa en 2021 y la osteoartritis, con el mayor incremento. Los TME se incrementaron con la edad y, con excepción de la gota, afectaron más a las mujeres. CONCLUSIONES: De 1990 a 2021, los TME constituyeron la principal causa de AVD en México, con mayor impacto en adultos y mujeres. Los TME se evidencian desde edades tempranas, de ahí la necesidad de intervenciones continuas para preservar la calidad de vida.

Employee medical leave in mis-tlif or open-tlif in elective surgery in brazil / Licença médica do empregado no mis-tlif ou open-tlif em cirurgia eletiva no brasil / Licencia médica del empleado en mis-tlif o open-tlif en cirugía electiva en brasil

ABSTRACT: Objective: To compare the effects of the two techniques (minimally invasive transforaminal inter somatic lumbar fusion [MIS-TLIF] and open transforaminal lumbar interbody fusion [TLIF]) in the treatment of lumbar degenerative disease. Methods: This is a retrospective cohort study. The outcomes investigated were: intensity of low back pain, functional disability of the lumbar spine, discharge time, return to work, lumbar lordosis angle, cost of individual sources due to the period of work-related absenteeism, and societal perspective costs in the treatment of low-grade lumbar degenerative disease. The data was obtained through the analysis of data contained in the electronic medical records of 100 patients who underwent one of the two surgical techniques from January 2019 to May 2021 in a High Complexity Orthopedic Surgery. The outcomes investigated were set 12 months postoperatively. Results: No statistical differences were observed in terms of sex, age, employment, and diagnosis grade between groups. MIS-TLIF was associated with significant improvement in the intensity of low back pain, functional disability of the lumbar spine, discharge time, return to work, cost of individual sources due to the period of work-related absenteeism, and societal perspective costs. The variation in the lumbar lordosis angle of the MIS-TLIF group was smaller when compared to TLIF. Conclusion: Considering that MIS-TLIF was achieved with satisfactory short-term improvements, it may be used as an alternative strategy to TLIF to promote clinical and economical improvements in treating lumbar degenerative disease. Level of Evidence III; Comparative Retrospective Study.

RESUMO: Objetivo: Comparar os efeitos das duas técnicas (fusão intersomática lombar transforaminal minimamente invasiva [MIS-TLIF] e fusão intersomática lombar transforaminal aberta [TLIF]) no tratamento da doença degenerativa lombar. Métodos: Trata-se de um estudo de coorte retrospectivo. Os desfechos investigados foram: intensidade da dor lombar, incapacidade funcional da coluna lombar, tempo de alta, retorno ao trabalho, ângulo de lordose lombar, costa de fontes individuais devido ao período de absenteísmo relacionado ao trabalho e custos da perspectiva social no tratamento de doença degenerativa lombar de baixo grau. Os dados foram obtidos por meio da análise dos dados contidos nos prontuários eletrônicos de 100 pacientes submetidos a uma das duas técnicas cirúrgicas no período de janeiro de 2019 a maio de 2021 em uma Cirurgia Ortopédica de Alta Complexidade. Os resultados investigados foram definidos 12 meses após a cirurgia. Resultados: Não foram observadas diferenças estatísticas quanto ao sexo, idade, vínculo empregatício, grau de diagnóstico entre os grupos. O MIS-TLIF foi associado a melhora significativa na intensidade da dor lombar, incapacidade funcional da coluna lombar, tempo de alta, retorno ao trabalho, custo de fontes individuais devido ao período de absenteísmo relacionado ao trabalho e custos de perspectiva social. A variação do ângulo da lordose lombar do grupo MIS-TLIF foi menor quando comparado ao TLIF. Conclusão: Considerando que o MIS-TLIF foi alcançado com melhoras satisfatórias em curto prazo, pode ser usado como uma estratégia alternativa ao TLIF para promover melhorias clínicas e econômicas no tratamento da doença degenerativa lombar. Nível de Evidência III; Estudo Retrospectivo Comparativo.

RESUMEN: Objetivo: Comparar los efectos de dos técnicas (fusión lumbar intersomática transforaminal mínimamente invasiva [MIS-TLIF] y fusión intersomática lumbar transforaminal abierta [TLIF]) en el tratamiento de la enfermedad degenerativa lumbar. Métodos: Este es un estudio de cohorte retrospectivo. Los desenlaces investigados fueron: intensidad del dolor lumbar, incapacidad funcional de la columna lumbar, tiempo de alta, regreso al trabajo, ángulo de lordosis lumbar, costa de fuentes individuales debido al período de ausentismo relacionado con el trabajo y costos de perspectiva social en el tratamiento de enfermedad degenerativa lumbar de bajo grado. Los datos se obtuvieron a través del análisis de los datos contenidos en las historias clínicas electrónicas de 100 pacientes que se sometieron a alguna de las dos técnicas quirúrgicas durante el período de enero de 2019 a mayo de 2021 en una Cirugía Ortopédica de Alta Complejidad. Los resultados investigados se establecieron 12 meses después de la operación. Resultados: No se observaron diferencias estadísticas en cuanto a sexo, edad, ocupación, grado de diagnóstico entre grupos. MIS-TLIF se asoció con una mejora significativa en la intensidad del dolor lumbar, la discapacidad funcional de la columna lumbar, el tiempo de alta, el regreso al trabajo, la costa de fuentes individuales debido al período de ausentismo relacionado con el trabajo y los costos de perspectiva social. La variación en el ángulo de lordosis lumbar del grupo MIS-TLIF fue menor en comparación con TLIF. Conclusión: considerando que MIS-TLIF se logró con mejoras satisfactorias a corto plazo, puede usarse como una estrategia alternativa a TLIF para promover mejoras clínicas y económicas en el tratamiento de la enfermedad degenerativa lumbar. Nivel de Evidencia III; Estudio Retrospectivo Comparativo.

Spine stabilization exercises are not superior to flexion exercises for ultrasound-detected muscle thickness changes in patients with chronic low back pain and lumbar spondylolisthesis / Los ejercicios de estabilización de la columna vertebral no son superiores a los ejercicios de flexión para los cambios de grosor muscular detectados por ecografía, en pacientes con lumbalgia crónica y espondilolistesis lumbar

Abstract: Introduction: exercise programs can reduce pain and improve functionality in patients with degenerative spondylolisthesis and chronic low back pain. However, there is still no consensus surrounding the superiority of any specific routine for exercise-induced trophic changes of lumbar muscles. The aim was to compare the changes in the primary lumbar stabilizing muscle thickness after spine stabilization exercises and flexion exercises in patients with spondylolisthesis and chronic low back pain. Material and methods: prospective, longitudinal and comparative study was carried out. Twenty-one treatment-naive patients with a diagnosis of both chronic low back pain and degenerative spondylolisthesis over the age of 50 were included. A physical therapist taught participants either spine stabilization exercises or flexion exercises to execute daily at home. The thickness of the primary lumbar muscles was measured through ultrasound (at rest and contraction) at baseline and three months. A Mann-Whitney U test and Wilcoxon signed-rank test were performed for comparisons, and Spearman's rank correlation coefficients were calculated for associations. Results: we did not find statistically between the exercise programs: all patients presented significant changes in the thickness of the multifidus muscle but in none of the other evaluated muscles. Conclusion: there is no difference between spine stabilization exercises and flexion exercises after three months in terms of the changes in muscle thickness evaluated by ultrasound.

Resumen: Introducción: el ejercicio reduce el dolor y mejora la funcionalidad en pacientes con dolor crónico lumbar y espondilolistesis degenerativa. Sin embargo, no existe a la fecha un consenso sobre la superioridad de algún programa de ejercicio para inducir cambios tróficos de los músculos estabilizadores lumbares, por lo que el objetivo fue comparar el trofismo de estos músculos mediante ultrasonido, con dos programas de ejercicio distintos: estabilización vertebral versus ejercicios flexores. Material y métodos: estudio prospectivo, longitudinal y comparativo, en veintiún pacientes mayores de 50 años, con dolor crónico lumbar y espondilolistesis degenerativa. Se entrenó a los pacientes para la ejecución diaria de ejercicio: estabilización lumbar o ejercicios flexores, los cuales fueron asignados por aleatorización como parte de un ECA en desarrollo. El trofismo muscular fue evaluado mediante ultrasonido al inicio y a tres meses. Las pruebas de U de Mann-Whitney y prueba de Wilcoxon se usaron para comparaciones entre grupos y para correlaciones se usaron los coeficientes de correlación de Spearman. Resultados: todos los pacientes presentaron ganancia en el trofismo de los músculos multífidos a tres meses, pero sin diferencias entre grupos de tratamiento. No se detectaron cambios significativos en el resto de los músculos evaluados. Conclusión: no encontramos diferencia significativa entre los ejercicios de estabilización lumbar y los ejercicios flexores, a tres meses de seguimiento, en términos de los cambios tróficos medidos por ultrasonido de los músculos estabilizadores lumbares.

Espondilodiscitis por haemophilus parainfluenzae: un reporte de caso / Spondylodiscitis due to haemophilus parainfluenzae: a case report

INTRODUCCIÓN Haemophilus parainfluenzae (HP) es un cocobacilo gram negativo y un patógeno oportunista. Rara vez se asocia a infecciones vertebrales o musculoesqueléticas, y está muy poco reportado en la literatura. PRESENTACIÓN DELO CASO Una mujer de 45 años, sana, que presentaba un historial de dos semanas de lumbalgia progresiva, fiebre, coriza y congestión nasal, y que tenía discitis intervertebral causada por HP, confirmada por dos hemocultivos positivos y hallazgos progresivos de resonancia magnética (RM) de columna lumbar. Los hallazgos de la RM fueron atípicos, y consistían en un absceso del psoas y pequeñas colecciones de líquido epidural e intraespinal anterior asociadas con espondilodiscitis. El diagnóstico inicial se retrasó debido a que la RM inicial no reveló hallazgos que sugirieran un proceso infeccioso. El tratamiento consistió en un ciclo prolongado de administración intravenosa seguida de antibióticos orales, lo que finalmente produjo una buena respuesta clínica. DISCUSIÓN Y CONCLUSIÓN El HP es un patógeno muy raro en la espondilodiscitis. No obstante, debe tenerse en cuenta, especialmente en pacientes que presentan lumbalgia y fiebre y/o bacteriemia por microorganismos gram negativos. El estudio inicial debe incluir una RM de la columna con contraste. Aunque es poco común, la espondilodiscitis y un absceso del psoas pueden presentarse concomitantemente. Los antibióticos prolongados son el pilar del tratamiento.

INTRODUCTION Haemophilus parainfluenzae (HP) is a gram-negative coccobacillus and an opportunistic pathogen. It is rarely associated with spinal- and musculoskeletal-site infections, and very little reported in the literature. CASE PRESENTATION An otherwise healthy, 45-year-old woman who presented with a two-week history of progressive low back pain, fever, coryza and nasal congestion, was found to have intervertebral discitis caused by HP, confirmed by two positive blood cultures and progressive lumbar spine magnetic resonance imaging (MRI) findings. The MRI findings were atypical, consisting of a psoas abscess and small anterior epidural and intraspinal fluid collections associated with spondylodiscitis. The initial diagnosis was delayed because the initial MRI failed to reveal findings suggestive of an infectious process. The treatment consisted of a long course of intravenous followed by oral antibiotics, ultimately yielding a good clinical response. DISCUSSION AND CONCLUSION Haemophilus parainfluenzae is a very rare pathogen in spondylodiscitis. Nonetheless, it should be considered, especially in patients presenting with low back pain and fever and/or gram negative bacteremia. The initial work-up should include contrast-enhanced MRI of the spine. Although rare, spondylodiscitis and a psoas abscess can present concomitantly. Prolonged antibiotics are the mainstay of treatment.

Análisis estadístico de los factores de riesgo asociados a las patologías de la columna lumbar para la población empleada / Statistical analysis of risk factors associated with lumbar spine pathologies for the employed population

Objetivo: Determinar los factores de riesgo de patologías lumbares en pacientes empleados y afiliados al sistema de salud, a partir de la exploración física, hábitos, antecedentes personales y factores de riesgo laborales. Material y Métodos: El diseño del estudio es retrospectivo, transversal. En una muestra de 668 adultos trabajadores del Ecuador, se aplicó y evaluó el modelo predictivo de respuesta binaria logit para identificar factores de riesgo y se usaron métodos de aprendizaje supervisado (árboles de clasificación) para clasificar a los pacientes según el grado de patología lumbar. Resultados: El modelo predictivo logístico presentó una sensibilidad del 62,5%, una especificidad del 63,7%, el área bajo la curva ROC fue 0,63 y se determinó una precisión del 63,4%.Conclusión: Los factores que aumentan el riesgo de la patología de columna lumbar más frecuente (lumbalgia) y en orden de importancia en los pacientes son: menor edad, sexo femenino, tienden a exponerse a factores de riesgo psicosocial en su trabajo

Objective: Determine the risk factors of lumbar pathologies in patients employed and affi-liated with the health system, based on physical examination, habits, personal history, and occupational risk factors.Materials and Methods: The study design is retrospective, cross-sectional. In a sample of 668 adult workers from Ecuador. The binary logit response predictive model was applied to identify risk factors and supervised learning methodology (classification trees) was used to classify patients according to the degree of lumbar pathology.Results: The logistic predictive model has a sensitivity of 62.5%, a specificity of 63.7%, the area under the ROC curve was 0.63, and precision of 63.4% was determined.Conclusion: The factors that increase the risk of the most frequent lumbar pathology (low back pain) in order of importance in patients are: younger age, female sex, tend to be expo-sed to psychosocial risk factors at work, and lower risk of having mechanical factors.

Características demográficas y laborales del personal de enfermería con lumbalgia en hospital público de Corrientes, 2021 / Demographic and occupational characteristics of the nursing staff with low back pain in the public hospital of Corrientes, 2021

El dolor lumbar es una enfermedad laboral frecuente en enfermería, asociado a exigencias del cargo y múltiples causas. La intensidad varía según postura y actividad física, acompañándose de limitación dolorosa del movimiento, ser localizado, referido o irradiado. Objetivo: Determinar las características demográficas y laborales del personal de enfermería que presenta dolor lumbar de un hospital público de Corrientes, capital en el año 2021. Metodología: Diseño cuantitativo, transversal, observacional. Población 170 trabajadores de enfermería del hospital. Se incluyeron aquellos con dolor lumbar y que no cursaban enfermedades crónicas o invalidantes. Los datos se recogieron mediante cuestionario de elaboración propia, validado mediante prueba piloto. Variables: edad, género, formación en enfermería, frecuencia, intensidad y duración del dolor, principal tipo de dolor, tratamiento farmacológico y no farmacológico, principal situación generadora, tipo de trabajo realizado, turno y antigüedad laboral. Resultados: Se analizaron las respuestas de 115 trabajadores con dolor lumbar; amplitud etaria 22 a 62 años, promedio 36 años; 67% mujeres. El dolor lumbar fue diario en 22%, frecuente en 35%, ocasional en 43%. Según intensidad, 13% manifestó dolor leve, 47% moderado y 40% severo. El dolor era diario en 10% de jóvenes, en 20% de adultos jóvenes, en 45% de adultos intermedios y en 59% de adultos tardíos. En duración, el 73% lo padecía en forma aguda y el 27% crónica. En localización del dolor, el 75% indicó padecer dolor localizado y 25% irradiado. Principales situaciones generadoras de lumbalgia, 51% al movilizar pacientes, 23% al permanecer de pie, 18% al trasladar objetos pesados. En la percepción del personal sobre tipo de trabajo habitual, el 41% indicó pesado y 12% muy pesado. El 86%de los encuestados utilizó AINES. Conclusión: La intensidad del dolor lumbar es menor en el personal más joven respecto a los mayores. Los más jóvenes refieren dolor localizado, los de mayor edad dolor irradiado. El principal desencadenante del dolor lumbar es la movilización de pacientes[AU]

Low back pain is a common occupational disease in nursing, associated with the demands of the position and multiple causes. Te intensity varies according to posture and physical activity, accompanied by painful limitation of movement, being localized, referred or irradiated. Objective: To determine the demographic and labor characteristics of the nursing staff that presents low back pain in a public hospital in Corrientes, capital in the year 2021. Methodology: Quantitative, cross-sectional, observational design. Population 170 hospital nursing workers. Tose with low back pain and who did not have chronic or disabling diseases were included. Te data was collected through a self-prepared questionnaire, validated through a pilot test. Variables: age, gender, nursing training, frequency, intensity and duration of pain, main type of pain, pharmacological and nonpharmacological treatment, main generating situation, type of work performed, shif and work seniority. Results: Te responses of 115 workers with low back pain were analyzed; age range 22 to 62 years, average 36 years; 67% women. Low back pain was daily in 22%, frequent in 35%, occasional in 43%. According to intensity, 13% reported mild pain, 47% moderate and 40% severe. Pain was daily in 10% of youth, 20% of young adults, 45% of middle adults, and 59% of late adults. In duration, 73% suffered from it acutely and 27% chronically. In pain location, 75% indicated localized pain and 25% irradiated. Main situations that generate low back pain, 51% when moving patients, 23% when standing, 18% when moving heavy objects. In the perception of the personnel on the type of habitual work, 41% indicated heavy and 12% very heavy. 86% of those surveyed used NSAIDs. Conclusion: Te intensity of low back pain is lower in the younger staff compared to the older ones. Te youngest refer localized pain, the oldest radiated pain. Te main trigger of low back pain is the mobilization of patients[AU]

A lombalgia é uma doença ocupacional comum na enfermagem, associada às demandas do cargo e a múltiplas causas. A intensidade varia de acordo com a postura e atividade física, acompanhada de limitação dolorosa do movimento, sendo localizada, referida ou irradiada. Objetivo: Determinar as características demográfcas e laborais da equipe de enfermagem que apresenta lombalgia em um hospital público de Corrientes, capital no ano de 2021. Metodologia: Desenho quantitativo, transversal, observacional. População 170 trabalhadores de enfermagem hospitalar. Foram incluídos aqueles com lombalgia e que não possuíam doenças crônicas ou incapacitantes. Os dados foram coletados por meio de um questionário autoelaborado, validado por meio de um teste piloto. Variáveis: idade, sexo, formação do enfermeiro, frequência, intensidade e duração da dor, principal tipo de dor, tratamento farmacológico e não farmacológico, principal situação geradora, tipo de trabalho realizado, turno e antiguidade no trabalho. Resultados: Foram analisadas as respostas de 115 trabalhadores com lombalgia; faixa etária de 22 a 62 anos, média de 36 anos; 67% mulheres. A dor lombar foi diária em 22%, frequente em 35%, ocasional em 43%. De acordo com a intensidade, 13% relataram dor leve, 47% moderada e 40% intensa. A dor foi diária em 10% dos jovens, 20% dos adultos jovens, 45% dos adultos intermediários e 59% dos adultos tardios. Em duração, 73% sofriam agudamente e 27% cronicamente. Na localização da dor, 75% indicaram dor localizada e 25% irradiada. Principais situações que geram lombalgia, 51% ao movimentar pacientes, 23% ao fcar em pé, 18% ao movimentar objetos pesados. Na percepção do pessoal sobre o tipo de trabalho habitual, 41% indicaram pesado e 12% muito pesado. 86% dos entrevistados usaram AINEs. Conclusão: A intensidade da dor lombar é menor na equipe mais jovem em comparação com a mais velha. Os mais jovens referem dor localizada, os mais velhos referem dor irradiada. O principal desencadeador da lombalgia é a mobilização dos pacientes[AU]

[Low back pain and abdominal aortic aneurysm: Red flags]. / Dolor lumbar y aneurisma de aorta abdominal: red flags.

Approximately 70% of adults will experience low back pain at some point in their life. Most of the cases cannot be identified a cause, being nonspecific pains. The clinical guidelines on the management of low back pain indicate suspecting the presence of serious processes by means of the so-called red flags. Abdominal aortic aneurysm in 91% of cases is accompanied by low back pain, hence its importance of including it as a differential diagnosis. We present the case of a 75-year-old man with low back pain, without improvement with conservative treatment, referred to a rehabilitation consultation 3months after the onset of symptoms, and in the event of warning signs, imaging studies are requested that show abdominal aortic aneurysm and mass right kidney. We must bear in mind the red flags in patients with low back pain, and thus avoid outcomes that can put their lives at risk.

Influence of comorbidities on pain intensity in patients with chronic low back pain. / Influencia de las comorbilidades en la intensidad del dolor en los pacientes con lumbalgia crónica.

OBJECTIVES: Chronic pain is a complex process that can vary depending on factors such as time evolution, mood, or even previous experiences. Our objective is to describe patient's characteristics from those who were referred with a diagnosis of low back pain in their first Pain Unit (PU) visit, and identify those factors that may interfere with their pain perception. METHODS: Inferential analysis was carried out from data recorded in the PU database of the Hospital de la Santa Creu y Sant Pau in Barcelona, from November 2012 to November 2018. The average pain intensity during the last 24 hours (EVN24) was quantified using data from the BPI (Brief Pain Inventory) questionnaire. Using multiple linear regression, the independent predictive factors related to pain intensity (EVN24) were assessed. RESULTS: Mood disorders (Degree of depresión acording HAD_D level) was the variable with the highest impact in pain perception. Using binary logistic regression for multivariate analysis, a model of variables related to pain intensity (EVN24) was obtained (R = 0.354, P < 0.001). CONCLUSIONS: The specialized treatment of low back pain in PUs must take into account the patient's profile and especially the affective disorders and associated comorbidities since they predict a greater intensity of pain. Consequently, the associated comorbidity not only affects the greater intensity of pain, but the physical characteristics that accompany the patient throughout the process can influence or even compromise treatment.

Activation of lumbar spine stabilizer muscles in people with chronic low back pain: a systematic review / Ativação dos músculos estabilizadores da coluna lombar em pessoas com dor lombar crônica: uma revisão sistemática / Activación de los músculos estabilizadores de la columna lumbar en personas con lumbalgia crónica: una revisión sistemática

ABSTRACT Objective: To compare the level of activation of the lumbar spine stabilizing muscles between people with chronic low back pain and healthy people. Methods: A systematic search was performed on May 10, 2021, of the following databases: PubMed, Physiotherapy Evidence Database and Cochrane Library. Inclusion and exclusion criteria were based on the PICO format. Two authors independently examined all articles that were selected for full reading. Disagreements were resolved through a discussion between the authors. Results: The bibliographical search identified 525 records, 165 of which were duplicates. After screening the titles, abstracts and the full text of the remaining 360 studies, 352 articles were excluded, and 8 articles were included in this review. The eight studies assessed the level of muscle activation in patients with chronic low back pain. In six studies patients with chronic low back pain had a higher activation level, in one study there was no statistically significant difference between groups,and in one study the activation level was lower in the chronic low back pain group. Discussion: This review was the first to review electromyography studies of the lumbar spine stabilizer muscles, covering all types of exposure procedures for evaluation. We believe that the recommendation of healthcare professionals for these patients to contract the stabilizer muscles are totally unnecessary. Conclusion: Patients with low back pain have a higher level of lumbar spine stabilizer muscle activation than healthy people. Level of evidence IIA; Systematic review of cohort studies.

RESUMO Objetivo: Comparar o nível de ativação dos músculos estabilizadores da coluna lombar entre pessoas com dor lombar crônica e pessoas saudáveis. Métodos: Uma busca sistemática foi realizada no dia 10 de maio de 2021nos seguintes bancos de dados: PubMed, Physiotherapy Evidence Database e Cochrane Library. Os critérios de inclusão e exclusão foram baseados no formato PICO. Dois autores examinaram todos os artigos que foram selecionados para a leitura completa de forma independente.As discordâncias foram resolvidas por meio de uma discussão entre os autores. Resultados: A pesquisa bibliográfica identificou 525 registros, dos quais 165 eram duplicatas. Depois da triagem dos títulos, resumos e texto completo dos 360 estudos restantes, 352 artigos foram excluídos e oito artigos foram incluídos nesta revisão. Os oito estudos avaliaram o nível da ativação muscular em pacientes com dor lombar crônica;em seis estudos pacientes com dor lombar crônica tiveram maior nível de ativação, em um estudo não houve diferença estatisticamente significante entre os grupos e em um estudo, o nível de ativação foi menor no grupo de dor lombar crônica. Discussão: Esta revisão foi a primeira a analisar estudos de eletromiografia dos músculos estabilizadores da coluna lombar, abrangendo todos os tipos de procedimentos de exposição para a avaliação. Podemos acreditar que as recomendações dos profissionais de saúde para que esses pacientes contraiam os músculos estabilizadores são totalmente desnecessárias. Conclusões: Os pacientes com lombalgia têm nível de ativação dos músculos estabilizadores da coluna lombar maior em comparação compessoas saudáveis. Nível de evidência IIA; Revisão sistemática de estudos de coorte.

RESUMEN Objetivo: Comparar el nivel de activación de los músculos estabilizadores de la columna lumbar entre personas con lumbalgia crónica y personas sanas. Métodos: Se realizó una búsqueda sistemática el 10 de mayo de 2021 en las siguientes bases de datos: PubMed, Physiotherapy Evidence Database y Cochrane Library. Los criterios de inclusión y exclusión se basaron en el formato PICO. Dos autores examinaron de forma independiente todos los artículos que se seleccionaron para su lectura completa. Los desacuerdos se resolvieron mediante una discusión entre los autores. Resultados: La búsqueda bibliográfica identificó 525 registros, de los cuales 165 eran duplicados. Tras seleccionar los títulos, los resúmenes y el texto completo de los 360 estudios restantes, se excluyeron 352 artículos y se incluyeron 8 artículos en esta revisión. Los ocho estudios evaluaron el nivel de activación muscular en pacientes con lumbalgia crónica; en seis estudios los pacientes con lumbalgia crónicapresentaron un nivel de activación más alto, en un estudio no hubo diferencias estadísticamente significativas entre los grupos y en un estudio,el nivel de activación fue más bajo en el grupo con lumbalgia crónica. Discusión: Esta revisión fue la primera en analizar los estudios de electromiografía de los músculos estabilizadores de la columna lumbar, abarcando todo tipo de procedimientos de exposición para evaluación. Podemos creer que las recomendaciones de los profesionales de la salud para que estos pacientes contraigan los músculos estabilizadores son totalmente innecesarias. Conclusiones: Los pacientes con lumbalgia tienen un mayor nivel de activación de los músculos estabilizadores de la columna lumbar en comparación con las personas sanas. Nivel de evidencia IIA; Revisión sistemática de estudios de cohortes.

The effect of pilates exercises on muscle electrical activation in adults with chronic low back pain: a systematic review / Efeito dos exercícios de pilates na ativação elétrica muscular em adultos com lombalgia crónica: revisão sistemática / El efecto de los ejercicios de pilates sobre la activación eléctrica muscular en adultos con lumbalgia crónica: revisión sistemática

ABSTRACT Low back pain is one of the most prevalent orthopedic conditions, affecting around 70% to 80% of the world's population at least once during their life times. Surface electromyography is an important tool for assessing the muscle function of the lumbar stabilizers. One of the best treatment options for patients with chronic low back pain (CLBP) is physical exercise, particular lyaerobic exercise and Pilates, as these can reduce short-term pain and disability, and improve balance. This review aims to identify the state of art regarding the benefits of pilates on the population with CLBP, evaluating changes in the muscular activation of the muscles of the lumbar region. Searches were conducted on the following databases: PubMed (Medline), Science Direct, Scopus, Web of Science, Cochrane, Ebsco and Scielo; including gray literature: Google Scholar, Grey Literature, Pro Quest Dissertations & Theses. The inclusion criteria were adults with low back pain for three months or more, with or without referred pain in the lower limbs; studies that used electromyographic variables; studies with a pain assessment measure at two different times; studies with physical exercise performed only using the Pilates method. Applying these criteria, the searches retrieved 439 abstracts. Of these, 44 articles were evaluated for eligibility, and three fulfilled the qualitative and quantitative synthesis criteria. The average methodological quality score on the Downs and Black checklist was 15 out of 28. It was therefore concluded that Pilates is an excellent option for the treatment of non-specific low back pain, promoting health and helping prevent low back pain among asymptomatic individuals. Level of evidence II; Systematic Review of Level II or Level I Studies with Discrepant Results.

RESUMO: A dor lombar é uma das condições ortopédicas mais prevalentes, afetando cerca de 70% a 80% da população mundial pelo menos uma vez na vida. A eletromiografia de superfície é um importante instrumento de avaliação da função muscular dos estabilizadores lombares. Uma das melhores opções de tratamento de pacientes com dor lombar crônica (DLC) é o exercício físico, principalmente exercícios aeróbicos e Pilates, considerando que podem reduzir a dor e a incapacidade a curto prazo e melhorar o equilíbrio. Esta revisão objetivou identificar o estado da arte quanto aos benefícios do pilates para a população com DLC, por meio da avaliação das alterações da ativação muscular dos músculos da região lombar. A pesquisa foi realizada nas seguintes bases de dados: PubMed (Medline), Science Direct, Scopus, Web of Science, Cochrane, Ebsco e Scielo, incluindo também literatura cinzenta: Google Acadêmico, Grey Literature, Pro Quest Dissertations & Theses. Os critérios de inclusão foram adultos com lombalgia há três meses ou mais meses, com ou sem dor referida nos membros inferiores; estudos que que usaram variáveis eletromiográficas; estudos com medida de avaliação da dor em dois momentos distintos; estudos com exercícios físicos realizados apenas com o método Pilates. Com esses critérios, foram identificados 439 resumos. Desse total, 44 artigos foram avaliados quanto à elegibilidade e três satisfizeram os critérios de síntese qualitativa e quantitativa. A pontuação média de qualidade metodológica foi 15 de 28 na lista de verificação Downs e Black. Concluiu-se, portanto, que o Pilates é uma excelente opção no tratamento de dores lombares não específicas, resultando na promoção de saúde e na prevenção desta condição para indivíduos assintomáticos. Nível de evidência II; Revisão sistemática de Estudos de Nível II ou Nível I com resultados discrepantes.

RESUMEN: La lumbalgia es una de las afecciones ortopédicas más prevalentes, que afecta a entre el 70% y 80 % de la población mundial al menos una vez en la vida. Las electromiografía de superficie es una herramienta importante para evaluar la función muscular de los estabilizadores lumbares. Una de las mejores opciones de tratamiento para pacientes con dolor lumbar crónico (DLC) es el ejercicio físico, concretamente los ejercicios aeróbicos y el pilates, ya que pueden reducir el dolor y la discapacidad a corto plazo y mejorar el equilibrio. Esta revisión tuvo como objetivo identificar el estado del arte en cuanto a los beneficios del pilates para la población con DLC, evaluando los cambios en la activación muscular de los músculos de la región lumbar. La investigación se realizó en las siguientes bases de datos: PubMed (Medline), Science Direct, Scopus, Web of Science, Cochrane, Ebsco y Scielo; incluyendo también la literatura gris: Google Scholar, Grey Literature, Pro Quest Dissertations & Theses. Los criterios de inclusión fueron adultos con lumbalgia durante 3 meses o más, con o sin dolor referido en miembros inferiores; estudios que han utilizado variables electromiográficas; estudios con medición de la evaluación del dolor en dos momentos diferentes; estudios con ejercicios físicos realizados sólo con el método Pilates. Con estos criterios, se identificaron 439 resúmenes. De este total, se evaluó la elegibilidad de 44 artículos y 3 cumplieron los criterios de síntesis cualitativa y cuantitativa. La puntuación media de calidad metodológica fue de 15 sobre 28 en la lista de verificación de Downs y Black. Por lo tanto, se concluyó que el Método Pilates es una excelente opción en el tratamiento de la lumbalgia inespecífica, lo que resulta en la promoción de la salud y prevención de este padecimiento para individuos asintomáticos. Nivel de evidencia II, Revisión sistemática de Estudios de nivel II o Nivel I con resultados discrepantes.

Treatment of non-specific chronic low back pain: resistance training with or without using weights? / Tratamiento de la lumbalgia crónica inespecífica: ¿entrenamiento de fuerza con o sin pesas? / Tratamento da lombalgia crônica inespecífica: treinamento resistido com ou sem pesos?

ABSTRACT Introduction: Dysfunction of the core muscles contributes to the persistence of pain in patients with chronic low back pain. Evidence shows that the active approach is beneficial in the rehabilitation of these patients. However, there is uncertainty as to the most effective methods or form of exercise, as the literature offers little guidance in this regard. Objective: To analyze and compare the impact on quality of life, function, flexibility, abdominal strength and abdominal fat rate in patients with non-specific chronic low back pain after a program of resistance training using two different forms of exercise. Methods: Thirty individuals, aged between 18 and 65 years, participated in the study. Twenty performed physical training program twice a week for eight weeks, and ten did not perform any physical exercises, but received guidance and pain relief. The physically active individuals were randomly divided in two groups and received similar resistance training, focusing on the same muscle groups. Ten performed training with dumbbells and bodybuilding machines (TRCP) and ten did not use this equipment (TRSP). All were assessed before and after the intervention, through questionnaires on quality of life and function, and tests for flexibility, abdominal strength and measurement of the abdominal fat rate. Results: In the intra-group comparison (initial vs eight weeks), there were no significant differences in quality of life in any of the groups. However, regarding function, the three groups showed significant improvement, with TRSP showing the best evolution. For flexibility and abdominal strength gain, TRCP showed the best evolution in both instruments. For decrease in abdominal fat rate, only TRCP showed significant differences. In the intergroup comparison, there were no significant differences for any of the evaluated outcomes. Conclusion: The two exercise programs were effective in improving function, flexibility and abdominal strength in patients with chronic, non-specific low back pain. However, there were no statistically significant differences in any of the outcomes in the comparison between groups. Level evidence II, Comparative prospective study.

RESUMEN Introducción: La disfunción de la musculatura del tronco contribuye para la persistencia del dolor en pacientes con lumbalgia crónica. La evidencia muestra que un enfoque activo para la rehabilitación de estos pacientes es beneficioso. Sin embargo, existe incertidumbre sobre qué método o modalidad es más eficaz, ya que la literatura existente ofrece poca orientación al respecto. Objetivo: Analizar y comparar el impacto en la calidad de vida, función, flexibilidad, fuerza abdominal y porcentaje de grasa abdominal en pacientes con lumbalgia crónica inespecífica, luego de realizar un programa de entrenamiento de resistencia utilizando dos modalidades diferentes. Métodos: Participaron del estudio 30 personas, entre 18 y 65 años; veinte de los cuales se sometieron a un programa de entrenamiento físico dos veces por semana durante ocho semanas, y diez no realizaron ejercicios físicos, pero recibieron orientación y medicación analgésica. Los individuos físicamente activos se dividieron en dos grupos, al azar, y recibieron un entrenamiento de resistencia similar, centrándose en los mismos grupos musculares. Diez se sometieron a entrenamiento con mancuernas y aparatos de musculación (TRCP) y diez no utilizaron esos equipos, realizando ejercicios funcionales (TRSP). Todos fueron evaluados antes y después de la intervención, mediante cuestionarios de calidad de vida y función, además de pruebas de flexibilidad, fuerza abdominal y medición del porcentaje de grasa abdominal. Resultados: En la comparación intragrupo (inicial x 8 semanas), no hubo cambios significativos en la calidad de vida en ninguno de los grupos. Para la función, los tres grupos mostraron una mejora significativa, con TRSP mostrando una mejor evolución. En cuanto a flexibilidad y aumento de la fuerza abdominal, TRCP se desempeñó mejor en ambos instrumentos. Para disminuir el porcentaje de grasa abdominal, solo TRCP mostró diferencias significativas. En la comparación intergrupal, no hubo diferencias estadísticamente significativas para ninguno de los resultados evaluados. Conclusión: Los dos programas de ejercicio fueron efectivos para mejorar la función abdominal, la flexibilidad y la fuerza en pacientes con dolor lumbar crónico inespecífico. Sin embargo, no hubo diferencias estadísticamente significativas en ninguno de los resultados en la comparación entre grupos. Nivel de evidencia II, Estudio prospectivo comparativo.

RESUMO Introdução: A disfunção da musculatura do tronco contribui para a persistência da dor em pacientes com lombalgia crônica. As evidências demonstram ser benéfica a abordagem ativa para reabilitação desses pacientes, porém, existem incertezas sobre qual método ou modalidade mais eficaz, uma vez que a literatura existente oferece poucas orientações nesse aspecto. Objetivo: Analisar e comparar o impacto na qualidade de vida, função, flexibilidade, força abdominal e percentual de gordura abdominal em pacientes com lombalgia crônica inespecífica, após a realização de programa de treinamento resistido utilizando duas modalidades diferentes. Métodos: Trinta indivíduos, entre 18 e 65 anos, participaram do estudo; sendo que 20 realizaram um programa de treinamento físico duas vezes por semana, durante oito semanas, e dez não realizaram exercícios físicos, porém receberam orientações e medicação analgésica. Os indivíduos ativos fisicamente foram divididos em dois grupos, aleatoriamente, e receberam treinamento resistido similar focado nos mesmos grupos musculares. Dez realizaram treinamento com halteres e aparelhos de musculação (TRCP) e dez não utilizaram esses equipamentos, realizando apenas exercícios funcionais (TRSP). Todos foram avaliados antes e após a intervenção, por meio de questionários de qualidade de vida e função, além de testes de flexibilidade, força abdominal e mensuração do percentual de gordura abdominal. Resultados: Na comparação intragrupo (inicial x oito semanas), não houve mudança significativa na qualidade de vida de nenhum dos grupos. No entanto, quanto à função, os três grupos apresentaram melhora significativa, com o TRSP demonstrando melhor evolução. Para flexibilidade e ganho de força abdominal, o TRCP demonstrou melhor evolução em ambos os instrumentos. Para diminuição do percentual de gordura abdominal, somente o TRCP apresentou diferenças significativas. Na comparação intergrupos, não houve diferença estatisticamente significativa para nenhum dos desfechos avaliados. Conclusão: Os dois programas de exercícios foram eficazes para melhora da função, flexibilidade e força abdominal em pacientes com lombalgia crônica inespecífica. No entanto, não houve diferença estatisticamente significativa em nenhum dos desfechos na comparação entre os grupos. Nível de evidência II, Estudo prospectivo comparativo.

Correlation between the modic i sign and images of vertebral instability / Correlação entre sinal modic i e imagem de instabilidade vertebral / Correlación entre signo de modic i e imagen de inestabilidad vertebral

ABSTRACT The lumbar region is highly affected by degenerative diseases and can be symptomatic as a result of inflammatory processes of the disc or segmental vertebral instability (SVI), according to concepts by White and Panjabi. Magnetic resonance imaging (MRI) and dynamic radiographs can be used to evaluate it. Objective: To determine whether images of Modic type I lesions are compatible with radiological vertebral instability. Methods: The MRIs and dynamic radiographs of 100 patients with a mean age of 46.94 years, 65 of whom were women and 35 of whom were men, were studied to evaluate the reaction of endplates according to Modic and SVI at levels L2-L3, L3-L4, L4-L5 and L5-S1. They were divided into 3 groups: A- Modic I and SVI; B- Modic I without SVI; and C- Without Modic I and SVI. Sex, age and type of disc were evaluated. Result: 46 Modic I lesions and 24 cases of SVI were recognized. There were 5 patients in Group A (OR 0.23, p=0.006), 38 in Group B; and 19 in Group C. No direct relationship between age and Modic I and/or SVI was observed. Pfirrmann grade 5 discs are 4.6 times more likely to present a Modic I signal. The most affected disc was L3-L4 for the Modic signal and L4-L5 with respect to the SVI, translational instability being more frequent. Conclusions: Modic type changes, identified by magnetic resonance, are clinically relevant in relation to low back pain, but their presence does not confirm either translational or angular instability. Level of evidence III; Cross-sectional cohort.

RESUMO A região lombar é altamente afetada por doenças degenerativas e pode ser sintomática em decorrência de processos inflamatórios do disco ou de instabilidade vertebral segmentar (IVS), de acordo com os conceitos de White e Panjabi. A ressonância magnética (RM) e as radiografias dinâmicas podem ser usadas para sua avaliação. Objetivo: Determinar se as lesões do tipo Modic I são imagens compatíveis com instabilidade vertebral radiológica. Métodos: Imagens de RM e radiografias dinâmicas de 100 pacientes (65 mulheres e 35 homens) com média de idade de 46,94 anos para avaliar a reação dos platôs de acordo com Modic e IVS nos níveis L2-L3, L3-L4, L4-L5 e L5-S1. Os pacientes foram divididos em três grupos: A - Modic I e IVS; B - Modic I sem IVS e C - Sem Modic e IVS e foram avaliados quanto a sexo, idade e tipo de disco. Resultados: Foram reconhecidas 46 lesões Modic I e 24 IVS. O Grupo A tinha 5 pacientes (OR 0,23 p.0,006), o Grupo B, 38 e o Grupo C, 19. Não se constatou relação direta entre a idades com Modic e/ou IVS. Os discos tipo 5 de Pfirrmann têm 4,6 vezes mais chances de apresentar sinal Modic I. Os discos mais afetados foram L3-L4 no sinal Modic e L4-L5 com relação ao IVS, sendo o translacional mais frequente. Conclusões: As mudanças do tipo Modic como dados de ressonância são clinicamente relevantes com relação à lombalgia, mas sua presença não confirma instabilidade translacional ou angular. Nível de evidência III; Coorte transversal.

RESUMEN La región lumbar es muy afectada por la enfermedades degenerativas y puede ser sintomática debido a procesos inflamatorios del disco o inestabilidad vertebral segmentaria (IVS), según los conceptos de White y Panjabi. La resonancia magnética (RM) y las radiografías dinámicas se pueden utilizar para su evaluación. Objetivo: Determinar si las lesiones tipo Modic I son imágenes compatibles con inestabilidad vertebral radiológica. Métodos: Imágenes de RM y de radiografías dinámicas de 100 pacientes (65 mujeres y 35 hombres) con promedio de edad de 46,94 años para evaluar la reacción de las mesetas según Modic e IVS en los niveles L2-L3, L3-L4, L4-L5 y L5-S1. Los pacientes se dividieron en tres grupos: A - Modic I e IVS; B - Modic I sin IVS y C - Sin Modic e IVS y fueron evaluados por sexo, edad y tipo de disco. Resultados: Se reconocieron 46 lesiones Modic I y 24 IVS. El Grupo A tenía 5 pacientes (OR 0,23 p.0,006), en Grupo B 38 y el Grupo C 19. No hubo relación directa entre la edad con Modic y/o IVS. Los discos tipo 5 de Pfirrmann tienen4,6 veces más probabilidad de presentar una señal Modic I. Los discos más afectados fueron L3-L4 en la señal de Modic y L4-L5 con respecto a la IVS, siendo el traslacional el más frecuente. Conclusiones: Los cambios de tipo Modic como datos de la resonancia, son clínicamente relevantes con relación al dolor lumbar pero su presencia no confirma la inestabilidad traslacional o angular. Nivel evidencia III; Cohorte transversal.

Artritis facetaria séptica en paciente joven sin factores de riesgo

Se reporta el caso de un varón de 22 años que presentó lumbalgia aguda grave sin respuesta a los analgésicos comunes. El estudio por resonancia magnética mostró un proceso inflamatorio en la articulación facetaria T8-T9 y una pequeña colección epidural. Se realizó drenaje con aguja bajo control tomográfico y el cultivo de la muestra aisló Streptococcus agalactiae. El paciente evolucionó en forma favorable a la terapia antibiótica administrada, penicilina G sódica intravenosa durante tres semanas y otros betalactámicos oral por 4 semanas. La infección piógena de las articulaciones facetarias es rara.