Acupotomy for third lumbar vertebrae transverse process syndrome: A protocol for systematic review.

BACKGROUND: Acupotomy has been widely used clinically to relieve low back pain. However, the efficacy of acupotomy for the third lumbar vertebrae transverse process syndrome is still uncertain. The aim of this study is to determine the effectiveness and safety of acupotomy therapy for the third lumbar vertebrae transverse process syndrome. METHODS: Relevant randomized controlled trials will be searched from the databases of PubMed, the Cochrane Library, Embase, the China National Knowledge Infrastructure, Wanfang Database, Chinese Science and Technology Periodical Database, and Chinese Biomedical Literature Database from their inception to May 2020. Two reviewers will independently select studies, collect data, and assess the methodology quality by the Cochrane risk of bias tool. The RevMan V.5.3 will be used for meta-analysis. RESULTS: This study will provide an assessment of the current state of acupotomy for the third lumbar vertebrae transverse process syndrome, aiming to show the efficacy and safety of acupotomy treatment. CONCLUSION: This study will provide evidence to judge whether acupotomy is an effective intervention for the third lumbar vertebrae transverse process syndrome. PROSPERO REGISTRATION NUMBER: CRD42019134945.

Accuracy of a Radiological Evaluation Method for Thoracic and Lumbar Spinal Curvatures Using Spinous Processes.

OBJECTIVE: The purpose of this study was to assess a radiographic method for spinal curvature evaluation in children, based on spinous processes, and identify its normality limits. METHODS: The sample consisted of 90 radiographic examinations of the spines of children in the sagittal plane. Thoracic and lumbar curvatures were evaluated using angular (apex angle [AA]) and linear (sagittal arrow [SA]) measurements based on the spinous processes. The same curvatures were also evaluated using the Cobb angle (CA) method, which is considered the gold standard. For concurrent validity (AA vs CA), Pearson's product-moment correlation coefficient, root-mean-square error, Pitman- Morgan test, and Bland-Altman analysis were used. For reproducibility (AA, SA, and CA), the intraclass correlation coefficient, standard error of measurement, and minimal detectable change measurements were used. RESULTS: A significant correlation was found between CA and AA measurements, as was a low root-mean-square error. The mean difference between the measurements was 0° for thoracic and lumbar curvatures, and the mean standard deviations of the differences were ±5.9° and 6.9°, respectively. The intraclass correlation coefficients of AA and SA were similar to or higher than the gold standard (CA). The standard error of measurement and minimal detectable change of the AA were always lower than the CA. CONCLUSION: This study determined the concurrent validity, as well as intra- and interrater reproducibility, of the radiographic measurements of kyphosis and lordosis in children.

Retained Lumbar Bullet: A Case Report of Chronic Lead Toxicity and Review of the Literature.

BACKGROUND: Lead toxicity from retained bullet fragments is difficult to both predict and diagnose, but important to treat early, given the potential severity of disease. Blood lead levels > 25 µg/dL and 40 µg/dL are considered toxic in children and adults, respectively. Symptoms may range from nonspecific constitutional symptoms to seizures and coma. Chelation is the mainstay therapy for lead poisoning and levels to treat depend on patient age, blood lead levels, and the presence of symptoms. CASE  REPORT: We present the case of a woman with symptoms of severe lead toxicity from 20-year-old retained bullet fragments. She had been seen by multiple providers for evaluation of each symptom, but a unifying diagnosis had not been found. After identifying this complication, she was treated appropriately and more serious complications were prevented. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We present this case to increase awareness among emergency physicians of lead toxicity in patients with a seemingly unrelated constellation of symptoms and a history of a previous gunshot wound with retained bullet or bullet fragments.

BIOMECHANICS OF THERAPEUTIC RIDING DURING THE DISEASES OF I-II DEGREE DYSPLASTIC LUMBAR AND STATIC (SHORT LEG) SCOLIOSIS.

The goal of the paper is to substantiate the essence of ridetherapy biomechanics as the pathogenetic therapeutic and prophylactic method at lumbar dysplastic (the I and II degrees) and static (short-legged induced) scoliosis. Uneven lower extremities caused by any reason and asymmetric support induce the change in the arrangement of trochantin to the vertebra and correspondingly the uneven loading of lumbar muscles. The asymmetric strength of lumbar muscles evoked by the change in rotator condition becomes the cause of the formation of scoliosis primary arc which, in its turn, causes a compensatory spinal curvature. In case of dysplastic scoliosis a leading role belongs to the beginning of dystrophic changes in intervertebral discs and its further decentration. At riding position the lower extremities are completely disengaged from the antigravity redistribution, the child is in direct contact with vibrations and jolts coming from the horseback; the antigravity loading is distributed on the muscles of the torso and thus, it creates an opportunity to purposefully affect the correction of the spine. During scoliosis the pathogenic essence of ridetherapy is due to the comprehensiveness of its procedures, expressed in the fact that during one procedure several factors are influenced simultaneously: nucleus pulpous, the torso and iliopsoas muscles, the antigravity system, etc. According to the clinical-functional and radiographic studies carried out in the dynamics on 11-16 years old adolescents it has been established that in those groups where the rehabilitation was conducted in a complex with ridetherapy the authentically higher results were obtained as compared to the groups where the rehabilitation was held using therapeutic exercises and massage.

Palpatory accuracy of lumbar spinous processes using multiple bony landmarks.

OBJECTIVE: Accurate localization of vertebral segments is crucial for many treatment procedures. The objective of this study was to determine accuracy of identification of lumbar spinous process levels by palpation. METHODS: Three examiners independently identified the spinous processes of L1-L4 on 60 prone volunteers using multiple bony landmarks including the sacral base, L5, Tuffier's line, T12, and the 12th ribs. The spinous processes were marked with radiopaque skin markers. Location of marker placement and presence of anatomical anomalies were determined by posteroanterior lumbar radiographs. Accuracy of marker placement and interobserver reliability were assessed using weighted κ values. Generalized linear mixed models and Cochran-Mantel-Haenszel tests assessed the relationship of accuracy to training level, presence of anatomical anomalies, and participant characteristics. RESULTS: Examiners identified a spinous process in 91% of vertebral assessments. Correct identification of vertebral level occurred 69% of the time (κ = 0.81; 95% confidence interval, 0.79-0.83). Faculty examiners were significantly more accurate in identifying the correct vertebral level than the resident examiner (67%-78% vs 51%, P ≤ .03). The presence of 12th rib anomalies decreased accuracy for all examiners (P ≤ .05), reducing accuracy from 74% to 55%. Accuracy was higher in male participants than in female participants (P = .01). Obesity significantly decreased accuracy (P = .0003) at L3 (50% vs 73%) and L4 (44% vs 72%). CONCLUSIONS: Identification of lumbar spinous processes using multiple landmarks was more accurate than previously reported values. However, accuracy was dependent on examiner experience, presence of anatomical anomalies, and participant characteristics.

A cross-sectional study comparing pain and disability levels in patients with low back pain with and without transitional lumbosacral vertebrae.

OBJECTIVE: To determine whether patients with transitional lumbosacral vertebrae report more pain and disability compared with patients with normal lumbar vertebrae. METHODS: Radiographic and questionnaire data were collected from 353 patients with low back pain. Back pain severity was measured using 2 scales: one for pain over the entire episode and the other for pain during the previous week. All patients completed the Revised Oswestry Disability Questionnaire before radiography was performed. Patients were divided into 2 groups: those with and those without a transitional lumbosacral vertebra. Differences between patient groups were investigated using the unpaired t test. Multiple linear regression analysis was applied to investigate the effect of the transitional lumbosacral vertebrae on pain and disability controlling for the effects of age and sex. RESULTS: Forty-three patients (12.2%) had a transitional lumbosacral vertebra. There were no differences in pain or disability levels between the 2 groups on any of the pain scales or Revised Oswestry subscales. Older patients reported significantly more pain (P = .039) and disability (P = .002) than younger patients. CONCLUSIONS: The presence of a transitional lumbosacral vertebra in this group of patients was not related to an increased level of reported low back pain or disability.

A case of severe low back pain associated with Richard disease (lumbosacral transitional vertebra).

The imaging findings in some cases of low back pain are difficult to describe and the pathophysiology is not clear because subjective findings are usually difficult to document. This report concerns a rare case about the lumbosacral joint causing persistent severe back pain which in itself does not usually have any pathological meaning. We describe the diagnosis, treatment, and outcome of a patient suffering from low back pain with lumbosacral transitional vertebra. The radiological examination showed the congenitally malformed transverse processes of the 5th lumbar vertebra to create a facet joint-like shape at the sacral ala region on both sides. Surgery resulted in immediate disappearance of the low back pain. When the lumbosacral junction shows some instability without fusion, the joint-like region could be the cause of low back pain. The lumbosacral transitional vertebra may be associated with low back pain. Electric denervation of the space between the transverse process of 5th lumbar vertebra and sacral ala is minimally invasive and effective for pain eradication.

Therapeutic cecostomy tubes in infants with imperforate anus and caudal agenesis.

BACKGROUND/PURPOSE: Caudal agenesis is indicative of a poor prognosis for achieving normal bowel function in children with high imperforate anus (HIA). Complications with impaction, soiling, megarectosigmoid, and adverse responses to rectal enemas are inevitable and associated with long-term psychosocial dysfunction. In an attempt to avoid these outcomes, the authors began a prospective evaluation in these high-risk patients of skin level cecostomy tubes placed in infancy. METHODS: Between October 1997 and March 2001, 8 infants with variants of caudal agenesis underwent presumptive therapeutic placement of a cecostomy tube in conjunction with colostomy closure (n = 7) and anal transposition (n = 1). Mean age at time of cecostomy placement was 16 months. Efficacy of daily irrigations with individually modified electrolyte solutions has been evaluated over the subsequent 1 to 41 months with a mean follow-up of 22 months. RESULTS: Effective daily colonic evacuation was achieved in 7 infants. Transient episodes of incomplete emptying often associated with soiling were resolved with adjustments in solution contents and volume. No patient has required admission for impaction, and only 1 patient has required rectal enemas. There have been no major complications, and minor problems with cramping, granulation tissue, and site discomfort quickly resolved. One patient with anal anastamotic stricture consistently has not responded to antegrade irrigation and continues to require intermittent rectal enemas and anal dilation. Attempts to wean the irrigations occur as the infants grow older and are able to participate in toilet training; however, in this preschool population, tapering of the frequency has been tolerated only transiently. CONCLUSIONS: Antegrade enemas via a cecostomy device are highly effective for bowel management in infants with HIA and caudal agenesis. They can be placed with minimal morbidity at the time of initial reconstruction or colostomy closure. Consideration of this procedure in all infants with HIA may be indicated.

The effectiveness of chiropractic management of fibromyalgia patients: a pilot study.

OBJECTIVE: To demonstrate the effectiveness of chiropractic management for fibromyalgia patients using reported pain levels, cervical and lumbar ranges of motion, strength, flexibility, tender points, myalgic score and perceived functional ability as outcome measures. DESIGN: A. Preliminary randomized control crossover trial. B. Before and after design. PATIENTS: Twenty-one rheumatology patients (25-70 yr). CHIROPRACTIC INTERVENTIONS: Treatment consisted of 4 wk of spinal manipulation, soft tissue therapy and passive stretching at the chiropractors' discretion. CONTROL INTERVENTION: Chiropractic management withheld for 4 wk with continuation of prescribed medication. MAIN OUTCOME MEASURES: Changes in scores on the Oswestry Pain Disability Index, Neck Disability Index, Visual Analogue Scale, straight leg raise and lumbar and cervical ranges of motion were observed. RESULTS: Chiropractic management improved patients' cervical and lumbar ranges of motion, straight leg raise and reported pain levels. These changes were judged to be clinically important within the confines of our sample only. CONCLUSIONS: Further study with a sample size of 81 (for 80% power at alpha < or = .05) is recommended to determine if these findings are generalizable to the target population of fibromyalgia suffers.

[Laser reflexotherapy in the combined treatment of neurogenic bladder dysfunction in children with caudal regression syndrome]. / Lazerorefleksoterapiia v kompleksnom lechenii neirogennoi disfunktsii mochevogo puzyria u detei s sindromom kaudalnoi regressii.

The authors propose to introduce low-energy laser reflexotherapy to the complex of rehabilitative therapy for children with neurogenic dysfunction of the urinary bladder. The laser causes no pain, which enables the procedure to be used in infants, eliminates unretarded contractions of a detrusor rather effectively. A continuous reproduction of this therapeutic complex can be achieved by a relatively long-term stabilization of urination in a third of the children.

Interexaminer reliability of eight evaluative dimensions of lumbar segmental abnormality: Part II.

OBJECTIVE: The objectives of this study were to assess the interexaminer agreement of palpation for soft tissue and osseous pain along with visual observations in the lumbar spine. Second, the interexaminer agreement of dermothermograph and surface electromyographic (EMG) scans of the lumbar spine were assessed. Third, to perform these evaluations on symptomatic low back patients. Finally, the most reliable measurements were combined in a multidimensional index of segmental lumbar abnormality, which was assessed for interexaminer agreement. DESIGN: This is an interexaminer reliability study of commonly used palpatory and instrumentation procedures used to assess lumbar segmental abnormality. SETTING: This study was conducted at Pain Assessment and Rehabilitation Center (PARC) and the Center for Clinical Studies (CCS) at Northwestern College of Chiropractic. PATIENTS: The patients involved in this study were symptomatic at the time of examination. The patients were recruited from the CCS clinic and PARC. RESULTS: Palpation for osseous pain produced kappa coefficients ranging from .48-.90. Palpation for soft tissue pain produced kappa coefficients that ranged from .40-.79 and the kappas for visual observation ranged from .34-.84. The dermothermograph and surface EMG scanner were also assessed with the kappa coefficient for their reliability in assessing lumbar segmental abnormality. The kappa coefficients ranged from -.13 to .59 for the surface EMG and 0- .63 for the dermothermograph measurements. Intraclass correlation coefficients for the surface EMG measurements ranged from .20-.55 and the dermothermograph measurements ranged from .01-.55. Palpation for pain (osseous and soft tissue) and visual observation were included in the multidimensional index of abnormality. The interexaminer agreement of detecting a manipulable lesion was evaluated by designating a lesion present with a positive two out of three tests. Kappa coefficients for the multidimensional index of lumbar abnormality ranged from a low of .05 to a high of .52. CONCLUSIONS: Palpation for pain (osseous and soft tissue) and visual observation produced good to excellent interexaminer agreement and were included in the multidimensional index of abnormality. The interexaminer agreement of surface EMG scans and dermothermograph measurements were poor and considered to be clinically unacceptable, thus were not included in the multidimensional index. Palpation for pain is the only spinal assessment procedure to show consistent reliability in a number of studies.

Facet tropism: comparison of plain film and computed tomography examinations.

This study compares the findings of plain film X-ray and computed CT examination in the diagnosis of facet orientation and the presence of tropism. Twenty consecutive patients having lumbar disc disease with sciatica were studied utilizing plain X-ray as well as CT scanning. A chiropractic radiologist read the films to determine if facet facings were sagittally, semi-sagittally or coronally oriented on both CT and plain X-ray study. CT was accepted as the most accurate method to determine the true facet orientation, and plain X-ray interpretation of facet orientation was compared to the CT reading. There was a statistically significant relationship in diagnosing tropism between plain film X-ray and CT readings, with a predictive accuracy that ranged from 58-84% across the three segmental levels. However, the exact concordance of plain film X-ray and CT readings for right and left facet facings was very low. This raises the question of how the profession defines diagnostic accuracy.

[Electric stimulation of spinal muscles during walking as a method of the treatment of scoliosis]. / Elektrostimuliatsiia myshts spiny v khod'be kak metod lecheniia skolioza.

In the article is summarized the experience of treatment of 15 patients with dysplastic lumbar scoliosis of the II and III degree by the method of electrostimulation of dorsal muscles by means of walking corrector. Stimulation of the given type has been employed as rehabilitation therapy after carrying out of the closed chemonucleolysis for the purpose of muscle jacket restoration. Stimulation of trunk muscles in walking allowed to increase correction and stability of vertebral column distortion. Dynamic observations of patients demonstrated stability of achieved curative effect. Therapy of described type can be employed in complex of conservative treatment of scoliosis.

[Correction of posture disorders and scoliosis in schoolchildren using functional biofeedback]. / Korrektsiia narushenii osadki i skolioza u shkol'nikov metodami funktsional'nogo bioupravleniia.

A novel technique is offered for correction of postural defects and early manifestations of scoliosis in schoolchildren using methods of functional biofeedback training. The technique allowed the patient to use the biofeedback signals informing on the degree of asymmetry in bioelectric activity of paravertebral muscles in static active straightening of the vertebral column. The data revealed a steady decrease in asymmetric activity indices in muscles erecting the column. This provided a physiological basis for a high clinical efficiency of the technique.

Anomalous lumbosacral articulations and low-back pain. Evaluation and treatment.

Eleven patients ranging from 13 to 76 years in age with low-back pain and asymmetric sacro-transverse joints were studied. Preoperatively, scintimetry was performed in eight of the patients, in all cases with normal results. Ten of the 11 patients had their sacrotransverse joint anesthesized in fluoroscopy. Nine of these experienced pain reduction or alleviation. Resection of the transverse process was performed in all cases. At follow-up, at 6 to 42 months postoperatively, seven patients reported total alleviation of pain, and two, significant improvement. Two patients had unchanged symptoms; one patient was 76 years of age, had associated degenerative changes of the spine, and had no effect of local anesthetics in his joint, and the other was a 13-year-old male competitive swimmer. The authors conclude that, in patients with anomalous unilateral lumbosacral articulations and low-back pain, in whom local anesthesia into the joint gives pain alleviation, resection of the transverse process may be a worthwhile procedure.

Sacroiliac syndrome associated with lumbosacral anomalies: a case report.

A successfully treated case of sacroiliac syndrome coexisting with lumbosacral anomalies is presented. Spinal manipulative therapy is not contraindicated if properly modified to account for the anomalous anatomical orientation.

Vertebral agenesis: comprehensive care and outcome.

There is little information concerning long-term outcome of vertebral agenesis. In this series of eight patients with variable severity of vertebral agenesis, three died during infancy, two of associated congenital anomalies involving the cardiorespiratory system and one of unknown causes. The remaining five have had no life-threatening problems. They have normal intellect, and the developmental achievements are adequate for their age. The five patients with the highest lesions were those born to diabetic mothers. We also discuss current concepts of comprehensive team management of such infants.

[Lumbosacral agenesis. Presentation of one case. Literature review and embriological considerations (author's transl)]. / Agenesia lumbosacra. Presentación de un caso. Revisión de la literatura y consideraciones embriológicas.

A case of a complete lumbosacral agenesis is presented, whose etiological factors are unknown. Clinically, motor deficit corresponded to the agenesis level, but the sensibility and the autonomous nervous system functions, which were conserved, partially, in lower levels than the normal ones in the agenesis. The case report is completed with electromiography, mielography, rectal biopsy, urography, cistography, opaque enema and inborn infection study. There are three facts: a partially conserved sensibility in the lower extremities, normal bladder function and above all, the presence of nervous parasympatics normal fibers in rectum wall, in contrast with the serious motor alteration just in the same medullar levels. Explanation of these facts suggest origin of an embryological source. It is assumed that the noxa must have acted between the third and the fourth weeks of pregnancy at a caudal cordomesoblast level, supposing that it did not affect neural crest.