The effect of different physical activity levels on muscle fiber size and type distribution of lumbar multifidus. A biopsy study on low back pain patient groups and healthy control subjects.

AIM: Previous studies examining the multifidus fiber characteristics among low back pain (LBP) patients have not considered the variable of physical activity. The present study sought to investigate the muscle fiber size and type distribution of the lumbar multifidus muscle among LBP patient groups with different physical activity levels and healthy controls. METHODS: Sixty-four patients were assigned to one of three groups named according to the physical activity level, determined for each patient by the International Physical Activity Questionnaire. These were low (LPA), medium (MPA) and high (HPA) physical activity groups. A control group comprising of 17 healthy individuals was also recruited. Muscle biopsy samples were obtained from the multifidus muscle at the level L4-L5. RESULTS: contrast with the control group, LBP patient groups showed a significantly higher Type II fiber distribution as well as reduced diameter in both fiber types (P<0.05). The physical activity level did not have an effect on multifidus characteristics since no significant differences were observed in fiber type and diameter (P>0.05) among LPA, MPA and HPA patient groups. Various pathological conditions were detected which were more pronounced in LBP groups compared to the control (P<0.05). Males had a larger fiber diameter compared to females for both fiber types (P<0.05). CONCLUSIONS: The results showed that the level of physical activity did not affect muscle fiber size and type distribution among LBP patients groups. These findings suggest that not only inactivity but also high physical activity levels can have an adverse effect on the multifidus muscle fiber characteristics.

Complications of anterior surgery in cervical spine trauma: an overview.

OBJECTIVE: Although anterior surgery for cervical spine injuries is a widespread procedure, articles regarding its overall complications are infrequently published in the literature. In the current study we focus on the complications encountered after anterior instrumented stabilization of cervical spine injuries and we discuss ways to minimize them. PATIENTS AND METHODS: Patients with unstable lower cervical spine injuries who underwent anterior surgery over a 15-year period were identified and 74 patients with adequate follow-up were included in the study. Indication for surgery was set by the instability criteria of White and Panjabi. Demographic information, initial neurological examination, surgical reports, imaging findings and follow-up records were evaluated. RESULTS: Complications were classified as intraoperative (technique-related) and postoperative. Although radiological "complications" were noted, they had no or minor clinical consequences for the patient. We identified 9 patients with clinically significant complications: no purchase of the screws, late angulation deformity, screw breakage, backout of the screws and postoperative hematoma. Overall, 3 out of 74 patients (4%) were reoperated due to significant screw backout causing dysphagia, no purchase of the screws being completely in the adjacent disc and screw breakage, respectively. CONCLUSION: Anterior surgery for cervical spine injuries can present several complications, yet the technique is in a way permissive, even during the learning curve. Considering the significant morbidity of these patients, the reported rate of clinically significant complications is considered acceptable, and it could be further minimized by good preoperative planning, careful surgical technique and the use of modern implants and instrumentation.

[Comparative study of the treatment of pertrochanteric fractures--trochanteric gamma nail vs. proximal femoral nail]. / Vergleichsstudie der Versorgung pertrochantärer Femurfrakturen -- trochanteric Gamma-Nagel vs. PFN.

AIM: We have performed a retrospective comparative study between the trochanteric gamma nail (TGN) and the proximal femoral nail (PFN). METHOD: During the period 1998-2003, 97 TGN and 83 PFN were used for the treatment of pertrochanteric fractures. Most of the fractures were of the A3 type according to the AO/ASIF classification. Clinical and radiological follow-ups were available for 87 TGN and 65 PFN. RESULTS: The mean operative time for the TGN was shorter than that for the PFN. Intraoperative complications were noted in 17.5 % and 28.8 % for the TGN and PFN groups, respectively. Late complications occurred in 18.4 % for TGN compared to 27.6 % of the PFN. Union was achieved in 94.2 % and 89.3 % of the patients treated with the TGN and PFN, respectively. The reoperation rates were 10.3 % and 24.6 % for the TGN and the PFN, respectively. Clinical outcomes were good for both groups (65 % in the TGN, 62 % in the PFN group). CONCLUSION: Treatment of pertrochanteric fractures using the TGN and PFN implants is quite reliable. The major complication was cut-out and occurred mostly in the PFN group, while varus deformity was more frequent in the TGN group. The PFN was associated with a higher rate of reoperation and longer operative time, probably due to a more demanding technique.

[Diagnosis of septic loosening of hip prosthesis with LeukoScan. SPECT scan with 99mTc-labeled monoclonal antibodies]. / Diagnose septischer Hüftprothesenlockerung via LeukoScan. SPECT-Scan mit 99mTc-markierten monoklonalen Antikörpern.

Diagnosis of septic loosening of hip endoprosthesis with antigranulocyte scintigraphy (AGS) was analysed. Twenty-one hip prostheses were studied using laboratory tests and, in cases of elevated values, three-phase bone scan (BS) and AGS. Elective SPECT/CT scans were performed. Histologic and microbiologic exams verified the diagnosis. The AGS analysis revealed sensitivity, specificity and accuracy of value 1, while positive and negative predictive values were also 1. BS showed sensitivity of 1 and specificity of 0.33. In three cases, SPECT/CT scans corroborated the AGS interpretation. This diagnostic algorithm proved effective in the detection of septic loosening of hip prostheses. AGS can be avoided without risk of infection being overlooked.

Distal tibial fractures and non-unions treated with shortened intramedullary nail.

We reviewed 18 patients, 14 with acute fractures and four with non-union of the distal tibia, treated between 1990 and 2001 with a shortened, reamed intramedullary nail. The mean follow-up was 38 (8-144) months. The fractures united at an average of 16 (12-18) weeks and the non-unions at 20 (12-30) weeks. Two patients required nail dynamization. No limb shortening nor material failures were seen. All patients returned to normal daily activities. Although technically demanding, intramedullary nailing for distal tibial fractures and non-unions with a shortened nail represents a safe and reliable method.