Clinical Course of Motor Deficits from Lumbosacral Radiculopathy Due to Disk Herniation.

BACKGROUND: The clinical course of motor deficits from lumbosacral radiculopathy appears to improve with or without surgery. Strength measurements have been confined to manual muscle testing (MMT) and have not been extensively followed and quantified in prior studies. OBJECTIVE: To determine if motor weakness and patient-reported outcomes related to lumbosacral radiculopathy improve without surgical intervention over the course of 12 months. DESIGN: Prospective observational cohort. SETTING: Outpatient academic spine practice. PARTICIPANTS: Adults with acute radicular weakness due to disk herniation. METHODS: Forty patients with radiculopathy and strength deficit were followed over a 12-month period. Objective strength and performance tests as well as survey-based measurements were collected at baseline and then every 3 months. Patients underwent comprehensive pain management and rehabilitation and/or surgical approaches as determined in coordination with the treating specialist. This study was approved by the institutional review board of Colorado. MAIN OUTCOME MEASUREMENTS: Testing of strength was through MMT, handheld dynamometer, and performance-based testing. Furthermore, visual analog scale, modified Oswestry Disability Index, and 36-Item Short Form Health Survey (SF-36) were used to measure pain and disability outcomes. RESULTS: Of the 40 patients, 33 (82.5%) did not have surgery; 7 (17.5%) had surgery. Twenty-four of the 33 patients (60%) did not undergo surgery and were followed for 12 months (Comprehensive Pain Management and Rehabilitation, Complete [CPM&R-C]), and 9 (22%) did not have surgery and lacked at least one follow-up evaluation (Comprehensive Pain Management and Rehabilitation, Incomplete [CPM&R-I]). No statistically significant differences were found on baseline measures of strength deficits and SF-36 domains between the CPM&R-C, Surgery, and CPM&R-I groups. Pain and disability scores in the Surgery group were significantly higher than in the CPM&R-C at baseline. There were statistically significant improvements in all areas of strength, pain, and function when comparing measurements at the 12-month follow-up to baseline in the CPM&R-C group. CONCLUSIONS: Individuals with motor deficits due to lumbosacral radiculopathy improve over time regardless of treatment choice. Most did not choose surgery, and almost all of these patients regained full strength at 1 year. Strength recovery typically occurred in the first 3 months, but there was ongoing recovery over the course of a year. LEVEL OF EVIDENCE: II.

The Effect of Decomposition on the Efficacy of Biometrics for Positive Identification.

Biometrics, unique measurable physiological and behavioral characteristics, are used to identify individuals in a variety of scenarios, including forensic investigations. However, data on the longevity of these indicators are incomplete. This study demonstrated that iris and fingerprint biometric data can be obtained up to four days postmortem in warmer seasons and 50 + days in the winter. It has been generally believed, but never studied, that iris recognition is only obtainable within the first 24 hours after death. However, this study showed that they remain viable for longer (2-34 days) depending upon the environmental conditions. Temperature, precipitation, insects, and scavenger activity were the primary factors affecting the retention of biometrics in decomposing human remains. While this study is an initial step in determining the utility of physiological biometrics across postmortem time, biometric research has the potential to make important contributions to human identification and the law enforcement, military, and medicolegal communities.

Residency and Beyond: Subspecialization Trends Among Graduating Physiatry Residents and the Musculoskeletal Curriculum.

Previous studies and informal surveys have demonstrated a trend among graduating physiatry residents who desired to practice in an outpatient musculoskeletal (MSK)- or spine-type setting. However, there has been no updated information on the current trend among graduating residents as well as sparse information on gauging if current trainees feel prepared on graduation to treat patients with such disorders. This article describes a prospective survey of graduating chief residents during the 2013-2014 academic year in which 72% of chief residents planned to pursue a fellowship. A total of 54% of those chief residents planned to pursue a pain, sports, or spine fellowship. Seventy-five percent of the responding chief residents reported that most of the residents in their program felt that the current amount of required rotations in MSK, sports, spine, or pain medicine was adequate and 85% felt comfortable practicing in a noninterventional spine or MSK position after graduation without a fellowship. The results of this survey provide an updated perspective on the current trends among graduating residents as well as how residents perceive their MSK curriculum. These results may prove useful when evaluating MSK curriculums and shaping resident education to maximize career goals.