Low level laser therapy (LLLT) for patients with sacroiliac joint pain.

BACKGROUND AND AIMS: Sacroiliac joint pain not associated with a major etiological factor is a common problem seen in the orthopedic clinical setting, but diagnosis is difficult because of the anatomical area and thus it is sometimes difficult to effect a complete cure. Low level laser therapy (LLLT) has been well-reported as having efficacy in difficult pain types, so the following preliminary study was designed to assess the efficacy of LLLT for sacroiliac pain. MATERIALS AND METHODS: Nine patients participated, 4 males and 5 females, average age of 50.4 yrs, who attended the outpatient department with sacroiliac pain. The usual major disorders were ruled out. Pain was assessed subjectively pre-and post-LLLT on a visual analog scale, and trunk range of motion was examined with the flexion test to obtain the pre- and post-treatment finger to floor distance (FFD). The LLLT system used was an 830 nm CW diode laser, 1000 mW, 30 sec/point (20 J/cm(2)) applied on the bilateral tender points twice/week for 5 weeks. Baseline and final assessment values (after the final treatment session) were compared with the Wilcoxon signed rank test (nonparametric score). RESULTS: All patients completed the study. Eight of the 9 patients showed significant pain improvement and 6 demonstrated significantly increased trunk mobility (P <0.05 for both). CONCLUSIONS: LLLT was effective for sacroiliac pain, and this may be due to improvement of the blood circulation of the strong ligaments which support the sacroiliac joint, activation of the descending inhibitory pathway, and the additional removal of irregularities of the sacroiliac joint articular surfaces. Further larger-scale studies are warranted.

Effects of blood on bone cement made of calcium phosphate: problems and advantages.

In recent years, calcium phosphate cements (CPCs) have frequently been used as bone substitutes in the field of orthopedic surgery. When CPC is used as a bone substitute in vivo, blood contamination is unavoidable. To date, however, no detailed study has been conducted focusing on how the physical properties of CPCs would change under the influence of blood. In this study, the effects of blood contamination on Biopex-R (BPR, PENTAX, Tokyo) are examined in vitro and in vivo. The compressive strength of BPR after setting decreased depending on the amount of contaminating blood. The BPR, which has set in vivo, not only has a fragile surface due to the contamination by blood, but also has a propensity to shorten and be destroyed during the early postoperative stage, especially in the bone exposed to loads. On the other hand, radiographic and histological features in vivo indicated that the absorption and the bone replacement of BPR were stimulated by blood contamination. In the clinical evaluation, the patient's own peripheral venous blood was added to the BPR. One year after the surgery, the absorption was noted around the hardened BPR. To advance CPCs (including BPR) as bioabsorbable bone replaceable materials, it is essential to utilize the patient's own blood in combination with the CPC.

Cervical myelopathy accompanied with hypoplasia of the posterior arch of the atlas: case report.

STUDY DESIGN: Case reports of 2 patients having cervical myelopathy accompanied with idiopathic hypoplasia of the posterior arch of the atlas. OBJECTIVE: A standard for the sagittal inside diameter (SID) of the vertebral foramen of the atlas was determined for use in the diagnosis of hypoplasia. From the point of view of short SID, the etiologies of myelopathy in patients with this disease were analyzed. SUMMARY OF BACKGROUND DATA: There is no established definition of hypoplasia of the atlantal vertebral foramen. The mechanism underlying the occurrence of this myelopathy in adulthood is unknown. METHODS: Lateral x-ray views of the cervical vertebrae of 150 Japanese men and 150 Japanese women were investigated, and the standard values of the SID were obtained. The features of myelopathy associated with this disease were analyzed in 2 cases managed at our facility and in the literature. RESULTS: The mean standard value was 34.4 mm in women and 37.1 mm in men, showing a significant sex difference (P<0.0001). When a case with a value -2 SD below the standard was regarded as having hypoplasia, case 1 (female) showed 25 mm, that is, -3.9 SD, and case 2 (male) showed 30 mm, that is, -2.7 SD. The space available for the spinal cord of the atlas was 8.0 mm in case 1 and 9.5 mm in case 2. Both patients showed atlantoaxial subluxation on images, but atlantodental interval on flexion in cases 1 and 2 was 3.8 and 4.5 mm, respectively, showing the degree to be mild. CONCLUSIONS: In the presence of congenital hypoplasia of the posterior arch of the atlas, the spinal cord is highly susceptible to injury because congenital spinal canal stenosis is present. Therefore, the presence of even a mild mechanical compressive lesion leads to myelopathy. Acquired mild atlantoaxial subluxation was associated with this hypoplasia, and the association was considered to be the mechanism underlying the occurrence of myelopathy in adulthood.

Innervation of the triangular fibrocartilage complex of the human wrist: quantitative immunohistochemical study.

The distribution of neural elements in the triangular fibrocartilage complex (TFCC) of the human wrists was studied via immunohistochemical staining of protein gene product (PGP) 9.5 and calcitonin gene-related peptide (CGRP). Articular branches projecting to the TFCC arose from the dorsal branch of the ulnar nerve in all wrists examined. The TFCC is subdivided into the following six regions: the articular disc proper (ADP), meniscus homolog (MH), radio-ulnar ligament (RUL), loose part of ulnar collateral ligament (lUCL), dense part of ulnar collateral ligament (dUCL), and internal portion (IP). The IP consists of a mixture of dense and loose connective tissues enclosed by the ADP, MH, RUL, and UCL, and resides deep in the prestyloid recess, which is a pit in the MH. The densities of PGP 9.5-positive neural elements, including free nerve endings, single nerve fibers, nerve fascicles, and perivascular neural nets, were significantly higher in the IP than in other regions. Some of the neural elements except for the perivascular neural nets were positive for CGRP. The high density of neural elements in the IP suggests that sensory nerves projecting to the TFCC enter into the IP and from there distribute to adjacent regions such as the MH and RUL. Free nerve endings are responsible for pain transmission. The high density of free nerve endings in the IP suggests that the IP is a source of ulnar side wrist pain.

A clinical study on serum prostaglandin E2 with low-level laser therapy.

METHODS: The subjects of this investigation consisted of 83 female patients that were treated in this department during the 2-year period from January 1999 to December 2002. Laser irradiation was applied for 3 min either every day or every other day for a total of 10 times. A diode semi-conductor laser with a wavelength of 830 nm and a photointensity of 1 W was used. Evaluations were performed before and after the series of 10 exposures to laser irradiation. The evaluation included the measurement of pain using the visual analog scale (VAS) and serum prostaglandin E(2) (pg/mL) measured by RIA-PEG. RESULTS: The analgesic effects were observed in 67 of 83 cases, or 80.7%. The VAS scores for the effective cases decreased after the irradiation series from 8.5 +/- 0.2, to 2.8 +/- 0.2 ( p < 0.001). The post-irradiation PGE(2) levels were lower than the pre-irradiation PGE(2) levels in the effective cases, which were 5.8 +/- 0.3 and 7.1 +/- 0.4 pg/mL, respectively ( p < 0.05). The postirradiation PGE(2) levels for the effective cases were lower than those for the ineffective cases, which were 5.8 +/- 0.3 and 7.3 +/- 0.9 pg/mL, respectively ( p < 0.05). CONCLUSIONS: Based on the above findings, the analgesic effects of LLLT were found to be valid. The serum PGE(2) levels are therefore considered to directly reflect nociceptive pain.

Treatment of distal radius fracture with the use of calcium phosphate bone cement as a filler.

A new procedure for unstable fractures of the distal radius is presented. It uses a nonbridging external fixator in conjunction with calcium phosphate bone cement through a limited exposure. The best indication for the new procedure is intra-articular fracture with some large displaced fragments in young adults. In the C2 or C3 type fractures according to AO classification, it is very difficult to obtain satisfactory fixation with a plate and screws due to comminution of the articular surface and metaphysical bone defects in many instances. After reduction of the articular surface, this new technique allows fixation of the comminuted fragments using half pins of a nonbridging external fixator. Furthermore, injection of calcium phosphate bone to the bone defect helps to make both the articular surface and the cortical bone stable. The nonbridging external fixator allows early exercises. However, it cannot be applied to all types of the fracture because of its structural limitations. The combination of nonbridging external fixation and calcium phosphate bone applications assures early exercise of the wrist.