Hip-spine syndrome, radiographic evaluation of the sagittal balance / Síndrome quadril-coluna, avaliação radiográfica no balanço sagital / Síndrome de columna-cadera, evaluación radiográfica en el balance sagital

ABSTRACT Objectives The hip-spine syndrome (HSS) is defined as the simultaneous degeneration of the hip and lumbar spine. The objective of this study is to quantify the sagittal balance values in the population with HSS and to compare them with the normal sagittal balance parameters. Methods A retrospective study was conducted in which 30 patients with HSS who were waiting for total hip arthroplasty (THA) were evaluated. The lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI) and spinopelvic harmony (SH) angles and the BMI of these patients were measured. Results Seventeen women and 13 men participated in the study, with a mean LL of 39.55°, a mean SS of 36.92°, a mean PT of 25.77°, a mean PI of 62.72°, a mean SH of 23.17° and a mean BMI of 25.55. Only the SS did not present a changed value when compared to the normal values of the population. Conclusions HSS is increasingly present in our environment due to the aging population. Sagittal balance is gaining more and more attention in studies related to spinal pathologies. All the parameters measured in this study, except for SS, presented altered values when compared to the populational means. Evidence Level II. Observational and retrospective study.

RESUMO Objetivos A síndrome quadril-coluna (SQC) é definida como a degeneração simultânea do quadril e da coluna lombar. O objetivo do presente estudo consiste em quantificar os valores do equilíbrio sagital na população com SQC e compará-los com os parâmetros normais do equilíbrio sagital. Métodos Foi realizado um estudo retrospectivo em que foram avaliados 30 pacientes com SQC aguardando cirurgia de artroplastia total de quadril (ATQ). Foram aferidos os ângulos de lordose lombar (LL), declive sacral (DS), versão pélvica (VP), incidência pélvica (IP), harmonia espinopélvica (HP) e o IMC dos pacientes no estudo. Resultados Participaram do estudo 17 mulheres e 13 homens, sendo que a LL média foi de 39,55°, DS 36,92°, VP 25,77°, IP 62,72°, HP 23,17° e IMC 25,55. Apenas o DS não apresentou valor alterado quando comparado aos valores normais da população. Conclusão A SQC está cada vez mais presente em nosso meio devido ao envelhecimento populacional. O equilíbrio sagital ganha cada vez mais espaço nos estudos relacionados às patologias da coluna vertebral. Com exceção do DS, os demais parâmetros medidos nesse estudo apresentaram valores alterados quando comparados à média populacional. Nível de Evidência II. Estudo observacional e retrospectivo.

RESUMEN Objetivos El Síndrome de Columna-Cadera (SCC) se define como la degeneración simultánea de la columna lumbar y la cadera. El objetivo del presente estudio consiste en cuantificar los valores del equilibrio sagital en la población con SCC y compararlos con los parámetros normales del equilibrio sagital. Métodos Se realizó un estudio retrospectivo en el que se evaluaron 30 pacientes con SCC que esperaban cirugía para artroplastia total de cadera (ATC). Fueron medidos los ángulos de lordosis lumbar (LL), pendiente sacra (PS), versión pélvica (VP), incidencia pélvica (IP), armonía espinopélvica (AP) y el IMC de los pacientes en el estudio. Resultados Participaron en el estudio 17 mujeres y 13 hombres, siendo que la LL promedio fue de 39,55 °, PS 36,92°, VP 25,77°, IP 62,72°, AP 23,17° e IMC 25,55. Sólo la PS no presentó un valor alterado, cuando comparado a los valores normales de la población. Conclusión El SCC está cada vez más presente en nuestro medio debido al envejecimiento poblacional. El equilibrio sagital está ganando cada vez más espacio en los estudios relacionados a las patologías de la columna vertebral. Con excepción de la PS, los demás parámetros medidos en este estudio presentaron valores alterados cuando comparados al promedio poblacional. Nivel de Evidencia II. Estudio observacional y retrospectivo.

Síndrome de Ehlers-Danlos hipermóvel: um relato de caso / Hypermobile Ehlers-Danlos syndrome: a case report

A síndrome de Ehlers-Danlos é estabelecida por distúrbios hereditários do tecido conjuntivo que tem como manifestações principais a hipermobilidade articular, a hiperextensibilidade da pele e a fragilidade de tecidos, como articulações, ligamentos, pele, vasos sanguíneos e órgãos internos. São reconhecidos 13 subtipos, de acordo com Classificação Internacional de 2017. Dentre estes, abordamos o hipermóvel, cujo diagnóstico é eminentemente clínico, com manifestações sistêmicas distintas. Esse artigo refere-se ao caso de uma paciente diagnosticada com síndrome de Ehlers-Danlos hipermóvel, tendo como intuito a atualização acerca dos novos critérios diagnósticos, assim como o diagnóstico precoce de tal raropatia.

Ehlers-Danlos syndrome is established through hereditary disorders of connective tissue, and has as its manifestations: joint hypermobility, skin hyperextensibility, and fragility of tissues such as joints, ligaments, skin, blood vessels, and internal organs. Thirteen subtypes have been recognized according to the 2017 International Classification. Among these, the hypermobile type, the diagnosis of which is eminently clinical, with distinct systemic manifestations, will be addressed. This article refers to the case of a patient diagnosed with hypermobile Ehlers-Danlos syndrome, with the objective of updating the new diagnostic criteria, as well as the early diagnosis of such a rare disease.

Revision surgery in lumbar degenerative disease

Introduction: Lumbar degenerative disease is a common health problem all over the world and the need for revision surgery is still high with variable results. The aim of the work: Is to evaluate the clinical and radiologic outcome in cases of redo surgery for lumbar degenerative pathology and to specify which pathology is responding well to revision surgery.Patients and methods: Forty eight patients were operated upon for revision of previous failed back surgery in Zagazig University Hospitals from August 2014 to April 2017. Selection of patients for revision surgery depends on confirmed radiological and clinical compression or instability. All patients were operated and followed for at least 6 months after surgery. VAS score was used as a tool for evaluation of back and leg pain.Results: There were 48 patients; with a mean age of 46.7 years (range 22-78).There were 29 males and 19 females. The dominant symptoms were unilateral sciatica in 30, bilateral in 11, low back pain in 23 patients.Neurogenic claudication was present in 4 cases. Type of surgery was redo discectomy in 31 cases, revision decompression for spinal canal stenosis in 4 cases, and posterior lumbar interbody fusion in 13 cases, with success rate of 96.8%, 75% and 84.6% respectively regarding improvement after surgery.Conclusion: Revision surgery of lumbar degenerative diseases gives excellent results provided that the patients are properly selected

Comparison of Clinical and Radiologic Results of Mini-Open Transforaminal Lumbar Interbody Fusion and Extreme Lateral Interbody Fusion Indirect Decompression for Degenerative Lumbar Spondylolisthesis

STUDY DESIGN: Retrospective study. PURPOSE: In this study, we compared the postoperative outcomes of extreme lateral interbody fusion (XLIF) indirect decompression with that of mini-open transforaminal lumbar interbody fusion (TLIF) in patients with lumbar degenerative spondylolisthesis. OVERVIEW OF LITERATURE: There are very few reports examining postoperative results of XLIF and minimally invasive TLIF for degenerative lumbar spondylolisthesis, and no reports comparing XLIF and mini-open TLIF. METHODS: Forty patients who underwent 1-level spinal fusion, either by XLIF indirect decompression (X group, 20 patients) or by mini-open TLIF (T group, 20 patients), for treatment of lumbar degenerative spondylolisthesis were included in this study. Invasiveness of surgery was evaluated on the basis of surgery time, blood loss, hospitalization period, and perioperative complications. The Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ), disc angle (DA), disc height (DH), and slipping length (SL) were evaluated before surgery, immediately after surgery, and at 12 months after surgery. Cross-sectional spinal canal area (CSA) was also measured before surgery and at 1 month after surgery. RESULTS: There was no significant difference between the groups in terms of surgery time or hospitalization period; however, X group showed a significant decrease in blood loss (p < 0.001). Serious complications were not observed in either group. In clinical assessment, no significant differences were observed between the groups with regard to the JOABPEQ results. The change in DH at 12 months after surgery increased significantly in the X group (p < 0.05), and the changes in DA and SL were not significantly different between the two groups. The change in CSA was significantly greater in the T group (p < 0.001). CONCLUSIONS: Postoperative clinical results were equally favorable for both procedures; however, in comparison with mini-open TLIF, less blood loss and greater correction of DH were observed in XLIF.

The Association between Temporomandibular Joint Disorders and Lumbar Diseases in Adults / 치위생과학회지

The purpose of this study was to examine the association between the symptoms of temporomandibular joint disorders and lumbar diseases in adults when the prevalence rate of osteoarthritis is increasing and to help develop health policies that can improve oral health and health in general. The study used representative data from the 5th Korea National Health and Nutrition Examination Survey phase 3 (2012). In total, we analyzed the data of 3,017 individuals aged over 50 years who participated in the health-related survey and underwent radiography of the lumbar joints. PASW statistics ver. 18.0 was used for analysis. This study revealed the following results: 16.1% experienced at least one symptom of temporomandibular joint disorders within the recent single year, 20.6% experienced lower back pain in the recent three months, and 30.6% had lumbar osteoarthritis revealed using radiography of the lumbar joints. Symptoms of temporomandibular joint disorders, lower back pain, and lumbar osteoarthritis were correlated with each other; the respondents who experienced symptoms of temporomandibular joint disorders had 1.70 times (95% confidence interval [CI], 1.30∼2.22) higher prevalence of lower back pain and 1.20 times (95% CI, 0.86∼1.68) higher prevalence of lumbar osteoarthritis than in those with no such difficulties. The results of this study confirmed that the symptoms of temporomandibular joint disorders affected lumbar diseases in adulthood. Therefore, adequate treatment and prevention of the symptoms of temporomandibular joint disorders in adults is expected to make crucial contributions to decreases in the prevalence rate of lumbar diseases and an improvement in the quality of life.

Les affections rhumatologiques de l'enfant

Objectif: Rapporter les étiologies des affections rhumatologiques de l'enfant congolais.Méthodes et patients :Etude transversale sur dossiers médicaux, menée dans les services de Rhumatologie et de Pédiatrie du CHU de Brazzaville, de juin 2007 à mai 2015, soit 8 ans. Ont été inclus les dossiers documentés d'enfants âgés de 0 à 16 ans, non drépanocytaires, hospitalisés pour une affection ostéo-articulaire non traumatique. 236 sur 80 800 dossiers ont été colligés à partir des registres, constituant la population cible. 114 dossiers (0,29%) répondant aux critères d'inclusion ont été retenus, constituant la population d'étude. Les variables d'étude portaient sur les données épidémiologiques et diagnostiques.Résultats :La population d'étude était constituée de 144 enfants, 58 filles (51%) et 56 garçons (49%), soit un sex-ratio de 0,94. L'âge moyen était de 9,4 ± 3,4 ans (extrêmes de 2 semaines de vie à 16 ans). La fréquence hospitalière des affections rhumatologiques était de 0,29%. La douleur était le principal motif de consultation (73,6%) suivie de la fièvre (20%). L'impotence fonctionnelle était le motif de consultation dans 6,1%. Le délai de consultation était inférieur à un mois dans 65,8% des cas. La durée moyenne d'hospitalisation était de 19,8 ± 20,8 jours. Trois grands groupes étiologiques se distinguaient :les ostéo-arthrites infectieuses (40,4%) : arthrite septique 22,0%, mal de Pott 18 ,4% ;les rhumatismes post infectieux(36,0%), exclusivement représentés par le rhumatisme articulaire aigu ;les rhumatismes inflammatoires chroniques(18,5%) dont l'arthrite juvénile idiopathique (16,7%).Conclusion : Peu fréquente en milieu hospitalier, les affections rhumatologiques de l'enfant sont dominées par les ostéo-arthrites infectieuses, le rhumatisme articulaire aigu, et l'arthrite juvénile idiopathique

Influence of Gonarthrosis on Sagittal Spinal Alignment

STUDY DESIGN: Research using radiographic findings. OBJECTIVES: To compare spinopelvic parameters in detail between normal subjects and those who had bilateral gonarthrosis with or without spondylosis. SUMMARY OF LITERATURE REVIEW: The relationship between knee joint flexion contracture and hypolordosis in the lumbar spine has been well established. However, spinopelvic parameters in subjects with gonarthrosis without flexion contracture have not been well described in the literature. MATERIALS AND METHODS: Fifty-seven male subjects in their 60s with bilateral gonarthrosis over Kellgren-Lawrence grade III were included. They were subdivided into the KS group (with spinal osteoarthritis, n=32) and the KN group (without spinal osteoarthritis, n=25). Normal asymptomatic subjects without disease in their back or leg were analyzed as the control group (NN; n=84). The following spinopelvic parameters were measured and compared; C7 plumbline (C7PL), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). RESULTS: In the KS group, the C7PL was significantly anteriorly displaced compared to the KN group (1.7±4.5 cm vs. −0.6±2.9 cm, p=0.031) and the NN group (1.7±4.5 cm vs. −0.5±2.9 cm, p=0.014). TK in the KN group was significantly smaller than in the NN group (25.4±8.8° vs. 30.1±8.3°, p=0.041). The KS group had the smallest value of LL, while the NN group had the largest value of LL (−23.2±48.7° vs. −44.9±33.8° vs. −57.3±8.5°, p<0.001). No significant difference was observed in PI, SS, or PT among the 3 groups. A strong correlation was found between LL and SS in the NN group (R=−0.776, p<0.01), while this correlation was moderate in the KN group (R=−0.355, p<0.01). CONCLUSIONS: Overall balance was maintained in the subjects who had gonarthrosis without spinal osteoarthritis. Subjects with gonarthrosis showed less LL, especially if they had spinal osteoarthritis. Further studies are needed to characterize the differences in these pelvic parameters, and to evaluate changes in individuals with knee joint flexion contracture.

Clinical and Radiological Outcomes after Microscopic Bilateral Decompression via a Unilateral Approach for Degenerative Lumbar Disease: Minimum 5-Year Follow-Up

STUDY DESIGN: A retrospective study. PURPOSE: To assess postoperative bone regrowth at surgical sites after lumbar decompression with >5 years of follow-up. Postoperative preservation of facet joints and segmental spinal instability following surgery were also evaluated. OVERVIEW OF LITERATURE: Previous reports have documented bone regrowth after conventional laminectomy or laminotomy and several factors associated with new bone formation. METHODS: Forty-nine patients who underwent microscopic bilateral decompression via a unilateral approach at L4–5 were reviewed. Primary outcomes included correlations among postoperative bone regrowth, preservation of facet joints, radiographic parameters, and clinical outcomes. Secondary outcomes included comparative analyses of radiographic parameters and clinical outcomes among preoperative diagnoses (lumbar spinal stenosis, degenerative spondylolisthesis, and degenerative lumbar scoliosis). RESULTS: The average value of bone regrowth at the latest follow-up was significantly higher on the dorsal side of the facet joint (3.4 mm) than on the ventral side (1.3 mm). Percent facet joint preservation was significantly smaller on the approach side (79.2%) than on the contralateral side (95.2%). Bone regrowth showed a significant inverse correlation with age, but no significant correlation was observed with facet joint preservation, gender, postoperative segmental spinal motion, or clinical outcomes. Subanalysis of these data revealed that bone regrowth at the latest follow-up was significantly greater in patients with degenerative lumbar scoliosis than in those with lumbar spinal stenosis. Postoperative segmental spinal motion at L4–L5 did not progress significantly in patients with degenerative spondylolisthesis or degenerative lumbar scoliosis compared with those with lumbar spinal stenosis. CONCLUSIONS: Microscopic bilateral decompression via a unilateral approach prevents postoperative spinal instability because of satisfactory preservation of facet joints, which may be the primary reason for inadequate bone regrowth. Postoperative bone regrowth was not related to clinical outcomes and postoperative segmental spinal instability.

Tratamiento quirúrgico de la estenosis lumbar degenerativa en octogenarios / Surgical treatment of degenerative lumbar stenosis in octogenarians

INTRODUCCIÓN: el diagnóstico de estenosis lumbar degenerativa se ha incrementado en años recientes y representa una parte importante de las actividades diarias de los cirujanos espinales. Los pacientes mayores de 80 años presentan características y comorbilidades que incrementan los riesgos perioperatorios y pueden ocasionar malos resultados. OBJETIVO: mostrar resultados en el tratamiento quirúrgico, mediante descompresión, de los pacientes mayores de 80 años con diagnóstico de estenosis lumbar degenerativa. MÉTODOS: estudio de intervención longitudinal prospectivo con 13 pacientes mayores de 80 años de edad, siete hombres y seis mujeres, diagnosticados e intervenidos por estenosis lumbar degenerativa entre el 1ro. de enero de 2005 y el 31 de octubre de 2011, en el Centro de Investigaciones en Longevidad, Envejecimiento y Salud, y evaluados dos años después. RESULTADOS: predominó la afectación de cuatro o más espacios intervertebrales, con más de dos años de padecer fundamentalmente del síntoma de claudicación de origen neurógeno, las comorbilidades de causas cardiovasculares y ocurrieron cinco complicaciones perioperatorias. La disminución del dolor y del nivel de discapacidad fue significativa, con predominio de resultados bueno y regular. CONCLUSIONES: el tratamiento quirúrgico de la estenosis lumbar degenerativa, en pacientes mayores de 80 años de edad, según nuestros resultados, produce efectos beneficiosos, con disminución de dolor y discapacidad y baja ocurrencia de complicaciones.

INTRODUCTION: the diagnosis of degenerative lumbar stenosis has increased in recent years and it represents an important part of the daily activities of spinal surgeons. Patients older than 80 have characteristics and comorbidities that increase the perioperative risk causing bad results. OBJECTIVe: show results in the surgical treatment by decompression of patients older than 80 years diagnosed with degenerative lumbar stenosis. METHODS: a prospective longitudinal intervention study was conducted in 13 patients older than 80 years of age, seven men and six women diagnosed and treated for degenerative lumbar stenosis, from January 1, 2005 to October 31, 2011, at the Center for Research in Longevity, Aging and Health, and they were evaluated two years later. RESULTS: predominant involvement of four or more intervertebral spaces, more than two years of suffering primarily symptom of neurogenic claudication, comorbidities and cardiovascular causes occurred five perioperative complications. Reducing pain and disability was significant, with a predominance of good and fair results. CONCLUSIONS: surgical treatment of degenerative lumbar stenosis, in patients older than 80 years, according to our results, produces beneficial effects, with reduced pain and disability and low occurrence of complications.

Significance of SCIWORA in adults / Significância da SCIWORA em adultos / Trascendencia del cuadro SCIWORA en adultos

Recognizing the importance of SCIWORA in adult age; analyze the usefulness of complementary studies; evaluating therapeutic options; learn about the evolution of the treated patients.

Reconhecer a importância de SCIWORA na idade adulta; analisar a utilidade dos estudos complementares; avaliar as opções terapêuticas; conhecer a evolução dos pacientes tratados.

Reconocer la importancia de SCIWORA en la edad adulta; analizar la utilidad de los estudios complementarios; evaluar las opciones terapéuticas; conocer la evolución de los pacientes tratados.

Análise do equilíbrio espinopélvico em pacientes com espondilolistesedegenerativa L4-L5 / Analysis of spinopelvic balance in patients with L4-L5 degenerative spondylolisthesis

Objetivos: Avaliar o equilíbrio espinopélvico em pacientes portadores de espondilolistese degenerativa L4-L5. Métodos: Analisamos as radiografias pré-operatórias lombopélvicas, em perfil, de 33 pacientes portadores de espondilolistese degenerativa L4-L5 para a mensuração dos parâmetros envolvidos no equilíbrio espinopélvico. Resultados: Dos 33 pacientes, 22 pertencem ao sexo feminino, com média de idade de 59 anos. A média da incidência pélvica (IP), inclinação pélvica (TILT) e inclinação sacral (SLOP) foi 61,4°; 22,1º e 38,3º, respectivamente, havendo correlação positiva entre IP e TILT e correlação negativa entre SLOP e TILT, ambas com significância estatística. Conclusão: Na espondilolistese degenerativa L4-L5, a IP, TILT e SLOP tiveram suas médias iguais a 61,4°, 38,3° e 22,1°, respectivamente, revelando alteração na conformação pélvica que culminou em um desequilíbrio espinopélvico nesses pacientes.

Objectives: To evaluate and analyze the spinopelvic balance in patients with L4-L5 degenerative spondylolisthesis. Methods: We analyzed the lumbopelvic preoperative radiographs in profile, 33 patients with L4-L5 degenerative spondylolisthesis to measure the parameters involved in spinopelvic balance as pelvic incidence (PI), pelvic tilt (TILT pelvic) and sacral slope (SLOP sacral). Results: Of the 33 patients with degenerative spondylolisthesis, 22 were female and the mean age was 59 years. The average IP, TILT and SLOP was 61.4°, 22.1° and 38.3°, respectively, with a positive correlation between IP and TILT and a negative correlation between SLOP and TILT, both with statistical significance. Conclusion: Patients with L4-L5 DS, IP, TILT and SLOP had their means equal to 61.4°, 38.3° and 22.1°, respectively, demonstrated that possibility the pelvic imbalance in these patients.

Ultrasound-guided facet block to low back pain: a case report / Bloqueio facetário guiado por ultrassom para lombalgia: relato de caso / Bloqueo facetario guiado por ultrasonido para lumbalgia: relato de caso

BACKGROUND: Osteoarthrosis is a common cause of low back pain. The diagnosis is clinical and can be confirmed by imaging studies. Pain treatment and confirmation of diagnosis are made by intra-articular injection of corticosteroid and by local anesthetic use, due to clinical improvement. A direct monitoring of the procedure can be done under fluoroscopy, a classic technique, or else by an ultrasound-guided procedure. CASE REPORT: Female patient, 88 years old, 1.68 m and 72 kg, with facet osteoarthrosis at L2-L3, L3-L4 and L4-L5 for two years. On physical examination, she exhibited pain on lateralization and spinal extension. We opted in favor of an ultrasound-guided facet joint block. A midline spinal longitudinal scan was obtained, with identification of the desired joint space at L3-L4. A 25 G needle was inserted into the skin by the echographic off-plane ultrasound technique. 1 mL of contrast was administered, with confirmation by fluoroscopy. After aspiration of the contrast, 1 mL of solution containing 0.25% bupivacaine hydrochloride and 10 mg of methylprednisolone acetate was injected. Injections into L3-L4, L2-L3 and L1-L2 to the right were applied. CONCLUSIONS: The visualization of the facet joint by ultrasound involves minimal risk, besides reduction of radiation. This option is suitable for a large part of the population. However, fluoroscopy and computed tomography remain as monitoring techniques indicated for patients with specific characteristics, such as obesity, severe degenerative diseases and anatomical malformations, in which the ultrasound technique is still in need of further study. .

JUSTIFICATIVA: a osteoartrose facetária é causa frequente de dor lombar. O diagnóstico é clínico e pode ser confirmado por imagem. O tratamento da dor e a confirmação do diagnóstico são feitos pela injeção intra-articular de corticosteroide e anestésico local, por causa da melhoria clínica. A monitoração direta do procedimento pode ser feita por fluoroscopia, técnica clássica, ou guiada por ultrassom. RELATO DE CASO: paciente do sexo feminino, 88 anos, 1,68 m e 72 kg, com osteoartrose facetária em L2-L3, L3-L4 e L4-L5 havia dois anos. No exame físico, dor à lateralização e à extensão da coluna. Optou-se pelo bloqueio da articulação facetária guiado por ultrassom. Foi feito escaneamento longitudinal na linha média da coluna vertebral e identificado o espaço articular desejado em L3-L4. Uma agulha 25G foi introduzida na pele pela técnica fora de plano ecográfico. Foi administrado 1 mL de contraste, confirmado com fluoroscopia. Após aspiração do contraste, foi injetado 1 mL de solução contendo cloridrato de bupivacaína 0,25% e 10 mg de acetato de metilprednisolona. Foram feitas injeções nos espaços L3-L4, L2-L3 e L1-L2 à direita. CONCLUSÕES: a visualização da articulação facetária pelo ultrassom determina mínimo risco e redução da radiação e é indicada para grande parte da população. Ainda assim a fluoroscopia e a tomografia computadorizada permanecem como monitoração indicada para pacientes com características específicas, como obesidade, doenças degenerativas intensas e malformações anatômicas, nas quais o ultrassom ainda necessita de mais estudos. .

JUSTIFICACIÓN: la osteoartrosis facetaria es causa frecuente de dolor lumbar. El diagnóstico es clínico y puede ser confirmado por imagen. El tratamiento del dolor y la confirmación del diagnóstico se hacen mediante la inyección intraarticular de corticosteroides y anestésico local para la mejoría clínica. La monitorización directa del procedimiento puede hacerse por fluoroscopia, técnica clásica, o guiada por ultrasonido. CASO CLÍNICO: paciente del sexo femenino, de 88 años, de 1,68 m y 72 kg, con osteoartrosis facetaria en L2-L3, L3-L4 y L4-L5 hacía ya 2 años. En el examen físico se constató dolor a la lateralización y a la extensión de la columna. Optamos por el bloqueo de la articulación facetaria guiado por ultrasonido. Se hizo un escaneo longitudinal en la línea media de la columna vertebral y se identificó el espacio articular deseado en L3-L4. Una aguja 25G se introdujo en la piel por la técnica fuera del plano ecográfico. Se administró 1 mL de contraste, confirmado con la fluoroscopia. Después de la aspiración del contraste, se inyectó 1 mL de solución conteniendo clorhidrato de bupivacaína al 0,25% y 10 mg de acetato de metilprednisolona. Se administraron inyecciones en los espacios L3-L4, L2-L3 y L1-L2 a la derecha. CONCLUSIONES: la visualización de la articulación facetaria por el ultrasonido determina un mínimo riesgo y una reducción de la radiación y está indicada para gran parte de la población. Pero incluso así, la fluoroscopia y la tomografía computadorizada permanecen como la monitorización indicada para pacientes con características específicas, como obesidad, enfermedades degenerativas intensas y malformaciones anatómicas, para las cuales el ultrasonido todavía necesita más estudios. .

Les atteintes osseuses drepanocytaires

Contexte : Les complications osseuses chez le drepanocytaire telles que l'osteonecrose; l'osteoarthrite et l'osteomyelite constituent une grande source de morbidite compromettant le plus souvent le pronostic fonctionnel du membre du patient. Patients et Methode : Il s'agissait d'une etude retrospective; descriptive realisee sur sur une periode 10 ans et concernant 210 patients drepanocytaires ayant presente au moins une des trois complications osseuses majeures. Resultats : L'age moyen etait de 19 ans avec des extremes de 02 a 43 ans. On notait un sex-ratio de 1;1 en faveur des hommes. Les atteintes osseuses sont l'apanage des formes homozygotes SSFA 2 (42;9) et ? 0 thalasso-drepanocytaires SFA 2 (26;2). Il s'agissait essentiellement d'osteomyelite (43;3); osteonecrose (47;2) et osteo-arthrite (9;5). Les localisations preferentielles de l'osteomyelite etaient le tibia et le perone (12;8); le femur (7;1) et l'humerus (6;2). La tete femorale (45;7) et humerale (1;4) etaient deux localisations quasi-constantes de l'osteonecrose. Quant a l'osteo-arthrite; l'atteinte de la hanche etait estimee a 24 des cas et le genou 5;7

Characteristics of Back Muscle Strength in Patients with Scheduled for Lumbar Fusion Surgery due to Symptomatic Lumbar Degenerative Diseases

STUDY DESIGN: Cross sectional study. PURPOSE: To evaluate characteristics of back muscle strength in patients scheduled for lumbar fusion surgery. OVERVIEW OF LITERATURE: Little is known regarding muscle strength in patients with symptomatic lumbar degenerative diseases who require fusion surgery. METHODS: Consecutive 354 patients scheduled for posterior lumbar interbody fusion due to symptomatic degenerative diseases were approached for participation. 316 patients were enrolled. Before surgery, muscle strength was assessed by measuring maximal isometric extension strength at seven angular positions (0degrees, 12degrees, 24degrees, 36degrees, 48degrees, 60degrees, and 72degrees) and mean isometric strength was calculated. The Oswestry Disability Index (0-100) and visual analogue scale (0-100) for back pain were recorded. Muscle strength was compared according to gender, age ( or =70 years) and scheduled fusion level (short, or =3). RESULTS: Isometric strength was significantly decreased compared with previously reported results of healthy individuals, particularly at extension positions (0degrees-48degrees, p0.05). Isometric strengths showed significant, but weak, inverse correlations with age and Oswestry Disability Index (r<0.4, p<0.05). CONCLUSIONS: In patients with symptomatic lumbar degenerative diseases, back muscle strength significantly decreased, particularly at lumbar extension positions, and in females and older patients.

Case-control study on needle-knife to cut off the medial branch of the lumbar posterior ramus under C-arm guiding for the treatment of low back pain caused by lumbar facet osteoarthritis / 中国骨伤

<p><b>OBJECTIVE</b>To study the clinical efficacy of needle-knife to cut off the medial branch of the lumbar posterior ramus under C-arm guiding to treat low back pain caused by lumbar facet osteoarthritis.</p><p><b>METHODS</b>From July 2009 to June 2011, 60 patients with low back pain caused by lumbar facet osteoarthritis were reviewed,including 34 males and 26 females, ranging in age from 39 to 73 years old,averaged 61.9 years old; the duration of the disease ranged from 6 to 120 months, with a mean of 18.9 months. All the patients were divided into two groups, 30 patients (18 males and 12 females, ranging in age from 39 to 71 years old, needle-knife group) were treated with needle-knife to cut off medial branch of the lumbar posterior ramus under C -arm guiding and the other 30 patients(16 males and 14 females, ranging in age from 41 to 73 years old, hormone injection group) were treated with hormone injection in lumbar facet joint under C-arm guiding. The preoperative JOA scores and the scores at the 1st, 12th and 26th weeks after treatment were analyzed.</p><p><b>RESULTS</b>Before treatment,the JOA scores between the two groups had no significant difference (P= 0.479); after 1 week of treatment, the JOA scores between the two groups had significant difference (P= 0.040), the improvement rate of hormone injection group was superior than that of the needle-knife group,which were (58.73+/-18.20)% in needle-knife group and (71.10+/-22.19)% in hormone injection group; after 12 weeks of treatment, the JOA scores between the two groups had no significant difference(P=0.569), and the improvement rate between the two groups had no significant difference,which were (50.09+/-19.33)% in the needle-knife group and (48.70+/-18.36)%) in the hormone injection group; after 26 weeks of treatment,the JOA scores between the two groups had significant difference (P=0.000), the improvement rate of hormone injection group was superior than that of the needle-knife group,which were (48.56+/-28.24)% in needle-knife group and (15.62+/-11.23 )% in hormone injection group.</p><p><b>CONCLUSION</b>Using needle-knife to cut off the medial branch of the lumbar posterior ramus could get longer efficacy than hormone injection in the treatment of lumbar facet osteoarthritis.</p>

Bloqueo radicular lumbar selectivo guiado por TAC Alternativa para diagnòstico y tratamiento de radiculopatìas originadas por hernias discales y/o artrosis facetarias / Selective lumbar radicular lock replacement for CT-guided diagnosis and treatment of radiculopathy caused by herniated discs and / or facet arthrosis

El presente estudio muestra experiencia en la realización de bloqueos facetarios periarticulares y radiculares lumbares guiados Por Toomografía Axial Computada (TAC), en pacientes con dolor lumbar, o lumbociático provocado por estenosis foraminales de diversas causas, especialmente las secundarias a hernias discales foraminales sin manifestaciones de déficit motor y artrosis facetarias, en estos casos, la causa del dolor se supone se debe ala isquemia que afecta directamente las raíces nerviosas y produce sìntomas. Se realizó la evaluaciòn de 55 pacientes a los que se les efectuó este procedimiento entre los años 2007-2010 con diagnóstico de radiculopatía lumbar provocados por estenosis foraminales secundarias a hernias discales foraminales sin manifestaciones de deficít motor y artrosis facetarias y que no mejorarón con tratamiento médico - kinésico en 4 a 6 semana. 40 Hombres y 15 mujeres con edades entre 35 y 84 años. se realizaron 45 bloqueos de raíces nerviosas, a 10 pacientes se le realizó en dos espacios simultáneo en forma homolateral, y 10 facetarios periarticulares, 8 en forma bilateral. el 90% de los pacientes y refirió mejoría inmediata después del procedimiento, con resultados variables a largo plazo. la duración de la mejoría del dolor fue variable y osciló en un rango de 15 días hasta en forma permanente en el 80% de los casos. Los procedimientos en su mayoría se realizaron con internación de 24 horas. No se presentaron complicaciones técnicas ni posteriores a la inyección. En nuestra experiencia los mejores resultados se encuentran en el dolor radicular con el diagnóstico de hernia discal foraminal. Se concluye con los bloqueos facetarios y radiculares constituyen un método diagnóstico y terapéutico que puede realizarse con mucha precisión y seguridad utilizando la ayuda de imágenes diagnósticas, especialmente la TAC siendo útiles para la localización del origen del dolor y para decidir un eventual tratamiento definitivo...

SUMMARY: The following study shows our experience doing TAC-guided lumbar facet periarticular and radicular blockades in patients with lumbar or lumbociatic pain caused by foraminal stenosis due to different causes, specially those secondary to foraminal disc herniantions without motor impairment and facetary arthrosis (in these cases, the cause of the pain is supposed to be due to ischemia affecting the nerve roots which causes the symptoms). We evaluated patients to whom the procedure was performed between 2007 and 2010, with diagnosis of lumbar radiculopathy caused by foraminal stenosis secondary to foraminal disc herniations without evidence of motor impairment and facetary arthrosis, whichdidn' t improve with kinesic medical treatment in 4 to 6 weeks. 55 patients were incluided, 40 men and 15 women, between 35 and 84 years. 45 nerve root blockades, in 10 patients it was done homolaterally in two space simultaneously, and 10 periarticular facetary blockades were performed, 8 bilateral, 90% of the patients refered immediate improvement of the symptoms after the procedure, with variable long-term results. The duration of the pain relief was variable and ranged from 15 days to permanent in 80% of the cases. In most of the cases the procedure was done with 24-hour hospital stay. There were no complications, neither technical nor following the injections. In our experience the best results are achieved in the treatment of radicular pain with the diagnosis of foraminal disc herniation. In conclusion, facetary and radicular blockades represent highly precise and safe, both therapeutic and diagnostic methods, that could be used with the aid of diagnostic images, specially TAC, to localize the origin of the pain as well as to decide an eventual definitive treatment.

The Association between the Bone Mineral Density and Spinal Osteoarthritis in Osteoporotic Thoracolumbar Compression Fractures

OBJECTIVES: The purpose of this study was to determine the association between the bone mineral density (BMD) and severity of spinal osteoarthritis (spondylosis) in osteoporotic spinal compression fracture. METHODS: Fifty six patients were evaluated 66 cases had an osteoporotic thoracolumbar compression fracture between January 2008 and June 2010. The average patient age was 76.2 years (M/F : 8/48). Age and body mass index (BMI, kg/m2) were measured, and the BMD was performed using peripheral quantitative computed tomography (pQCT). Simple thoracolumbar (T-L) spine lateral radiography was evaluated for three criteria: presence of osteophytes, disc space narrowing and vertebral body sclerosis. The findings were graded 0 to 3 and analyzed statistically for a correlation with the BMD and fractured vertebrae. RESULTS: Acute compression fractures comprised of 15 cases and the most common site of acute fractures with old fractures was lumbar spine (L1; 30 cases, 45.4%). The average of BMI was 23.32 and BMD (T-score) was -4.47. Pearson's rho showed a positive association between the weight, height and the BMD (P < 0.01). In terms of the BMD versus spondylosis, there was a positive association with high score in the high order cortical bone. Compression fractures occurrence rate in the absent and present of spondylosis was 74.3% and 22.4%, and 69% occur in the spinal segmental with no bony spur with chi-square test (P < 0.01). CONCLUSION: In the present of spondylosis was high score of cortical BMD and low rate of compression fracture. Spondylosis could be one of a factor of the occurrence in acute and adjacent compression fracture after old fractures.

Painkilling effect of ozone-oxygen injection on spine and joint osteoarthritis

To analyze the painkilling effect of ozone-oxygen injection on joint and spine osteoarthritis. This prospective study was completed at the Ozone Clinic, Rashid Hospital, Dubai, United Arab Emirates on 220 mainly local patients [122 women, mean age 47.05 years; 98 men, mean age 52.8 years] with radiographic documented spine or extremities osteoarthritis. The patients were treated over 3 years [September 2002 to August 2005] by ozone-oxygen injection twice a week for at least 12 sessions. Using the 6 faces pain scale; the patients' pain was recorded at the beginning and at the 4th, 8th, and 12th sessions. They were followed for a mean of 8.48 months and their pain scale was recorded at that time too. Comparison of the patients' 1st day pains with their 4th, 8th, and 12th sessions' pains showed a significant decrease [1st day to 4th session p=0.005, 1st day to 8th week p=0.005, 1st day to 12th session p=0.0043]. Comparison of the 1st day pain with the final follow-up pain, which was around 10 months from the first treatment, showed a meaningful decrease of pain [p=0.0048]. This study validates the painkilling effect of ozone-oxygen injection on osteoarthritis of the joints and spine. Its long term effect on pain advocates the likelihood of some histological changes as mechanism of its action

Frequency of Vertebral Compression Fractures in Spinal Osteoarthritis Patients in Relation to Bone Mineral Density / 대한류마티스학회지

OBJECTIVE: To investigate the association between bone mineral density (BMD) and osteoporotic compression fractures in radiographic spinal osteoarthritis (OA) patients. METHODS: Subjects were 382 female patients (ages 45 to 85) from outpatient clinic for osteoporosis and rheumatic diseases. BMD was measured at lumbar spine and hip by dual X-ray absorptiometry (Hologic QDR 2000). The standard anteroposterior and lateral plain radiographs of thoracic and lumbar spine were taken to define spinal OA and vertebral compression fractures. Radiographic spinal OA was defined by grade of disc degeneration and facet joint degeneration. Frequency of vertebral fractures was compared between spinal OA and control patients in relation to their BMD, age, weight, body mass index (BMI) and years post menopause. RESULTS: Higher proportion of fracture cases were observed in spinal OA patients than non-spinal OA patients (34.1%, 44/129 vs. 18.2%, 46/253, p<0.001) despite comparable mean BMD (0.836+/-0.152 vs. 0.834+/-0.185, p=0.89) and older mean age (65.8+/-8.5 vs. 57.8+/-10.3, p<0.001). In subjects of ages from 65 to 74, spinal OA patients showed significantly higher BMD than non-spinal OA patients (0.784+/-0.125 vs. 0.719+/-0.119, p=0.007), but the frequency of fractures seems to be higher than that of non-spinal OA patients (44.9%, 22/50 patients vs. 34%,19/55 patients, p=0.58). When all study subjects were stratified according to their spine BMD (normal, osteopenia, and osteoporosis), significantly higher proportion of vertebral compression fractures was noted in spinal OA than non-spinal OA patients in osteopenia group (38.5% vs. 13.5%, p<0.001). CONCLUSION: Higher BMD does not seem to be translated directly into decreased risk of osteoporotic compression fractures in spinal OA patients. Careful assessment of risk factors for osteoporotic fractures and newer methods for assessing bone strength in this group of patients are needed.

Efficacy of Bee Venom Injection for Osteoarthritis Patients / 대한류마티스학회지

OBJECTIVES: Bee venom contains a potent antiinflammatory peptide 401 as well as mellitin. The purpose of this study was to see the efficacy and safety of purified bee venom injection therapy for knee or spinal osteoarthritis patients. METHODS: One hundred and one osteoarthritis patients were randomly assigned to bee venom injection therapy or oral nabumetone medication group. Bee venom injection group was subdivided into 3 groups according to different dosing schedule(group A: gradual increase up to 0.7mg, group B: up to 1.5mg and group C: up to 2.0mg). Control group patients(group D) were given 1000mg nabumetone daily for 6 weeks. There were 25, 26, 25, and 26 patients assigned to A, B, C, or D group. The efficacy of treatment was evaluated by measuring instruments developed by authors, and the safety of bee venom injection was evaluated by hematology and chemistry laboratory examination. RESULTS: Among 101 patients, eighty-one patients completed the study, but twenty patients were dropped out and two of these patients were dropped out due to adverse drug reaction. The efficacy in bee venom group showed better improvement than nabumetone group(p<0.01). Within bee venom group, group B and C showed better improvement than group A(p<0.01). Itching around injection site occurred in most patients, and bodyache occurred in 49 patients (81.7%). Hemoglobin was decreased(0.3g/dl) in group C, but no significant changes were observed in other laboratory values. CONCLUSION: The efficacy of bee venom injection in the control of knee or back pain in osteoarthritis patients was better than nabumetone medication. No severe allergic or adverse reaction was observed in bee venom treatment patients, but problems related with bee venom injection, such as pruritis, bodyache, and the possibility of anaphylaxis, should be considered for the use of bee venom injection.