The Flexion Relaxation Phenomenon in Patients with Radiculopathy and Low Back Pain: A Cross-Sectional Study.

Although the measurements of the lumbar spine and pelvic flexion have shown that subjects with radiculopathy exhibited greater decreases of motion when compared with subjects with low back pain, there is still a lack of evidence regarding the changes in flexion relaxation ratio in patients with radiculopathy. The aims of this study were to investigate the flexion relaxation ratio and flexion of the lumbar spine and pelvis in subjects with low back pain (LBP) and LBP with radiculopathy (LBPR) in comparison with healthy subjects (CG-control group). A total of 146 participants were divided in three groups: LBP patients (54 males; 21 females); LBPR patients (26 males; 11 females); and CG subjects (16 males; 18 females). The lumbar spine and pelvis flexion was recorded using optoelectronic motion capture system. The electrical activity of the erector spinae muscles was assessed by surface electromyography during flexion-extension movements. Comparisons between groups were made using one-way ANOVA tests and Mann-Whithney U test with the level of statistical significance at 0.05. The lumbar and pelvic flexion and electromyography of the erector spinae muscle showed significant differences between LBP and LBPR patients compared to CG. Patients LBPR showed significantly smaller angles of lumbar and pelvic flexion compared to LBP patients and CG. An increase in the erector spinae muscle activity during flexion was also observed in patients with radiculopathy. The increased muscular activity of the erector spinae is related to the reduced flexion of the lumbar spine in order to protect the lumbar spine structure. Measurements of trunk, lumbar spine and pelvic flexion, and the flexion relaxation ratio may allow us to predict better outcomes or responsiveness to treatment of LBPR patients in the future.

Reg3G gene expression in regenerating skeletal muscle and corresponding nerve.

INTRODUCTION: The Reg genes play a major role in the regeneration of various tissues; however, no reports have been published regarding expression of the Reg3G gene in skeletal muscle. In this study we investigated the expression of the Reg3G gene in regeneration of rat skeletal muscle and injured nerves. METHODS: We used 3 experimental models of muscle and nerve injury. RT-PCR and Western blot analysis were performed for detection of Reg3G in regenerating muscle and nerve. RESULTS: We found transcriptional activation of the Reg3G gene in the soleus and extensor digitorum longus muscles and in their corresponding nerves after both muscle and nerve injury in different time periods, respectively. CONCLUSIONS: The results suggest that the Reg3G gene plays a major role in communication between injured axons and muscle and may play a significant role in skeletal muscle and peripheral nerve regeneration.

Risk factors for subdural bleeding in elderly population.

In the elderly, a larger proportion of the intracranial bleeds is related to non-traumatic causes or is caused by slight trauma--such that in a younger patient would not be expected to cause a bleed. In clinical practice, there is a prevailing impression that these bleeds, especially subdural hematomas of chronic and sub-chronic duration with or without acutization (evidence of "fresh" bleeding) are in many cases related directly to the use of anticoagulant therapy. A retrospective survey of medical documentation was performed for patients treated at the Neurosurgery Clinic of KBC Rijeka during the period of 2011 and 2012. Statistical analysis showed a significantly greater incidence of spontaneous SDH (subdural hematoma) in patients taking oral anticoagulation therapy (Fisher exact test, p < 0.01). In the article 3 typical cases of such patients are also presented. This survey confirmed the existence of a relationship between oral anticoagulant therapy and SDH, in particular the subgroup of "spontaneous" SDH. A larger study is planned.

Neurosurgical procedure for treatment of traumatic subdural hematoma with severe brain injury: a single center matched-pair analysis.

Decompressive craniectomy (DC), an auxiliary neurosurgical invasive procedure, has been a part of the treatment regimen for severe brain injury (SBI). Today DC is the standard of care in patients with middle cerebral artery infarction. Our previous positive research results about effectiveness of DC procedure when applied to a specific group of SBIlpatients have made a solid base for a clinical evaluation of DC technique application to patients with isolated SBI with traumatic subdural hematoma (TSDH), despite controversies regarding clinical benefit of DC technique when applied to STBI patients. A matched-pair analysis has been performed to compare long-term clinical outcomes in patients with and without the DC technique applied. This study has encompassed 150 consecutive STBI patients with TSDH, aged between 18 and 82 years. One hundred patients had required application of DC procedure, while remaining 50 patients represented a matched control group in which the DCprocedure had not been applied. The control group match was conducted on the basis of epidemiological and potential prognostic factors, such as age, gender, DC surface area and Glasgow Coma Score (GCS). The main reason for occurrence of STBI with TSDH was traffic accidents, with sex ration 2:1 (male/female), while 2/3 of patients were aged between 26 and 40 years. Mortality rate of 18% had occurred in the group of patients in which DC procedure was applied early in the first 24 hours after the injury, while mortality rate of 54% had occurred in the group of patients in which DC procedure was applied later than 24 hours after the injury, in comparison to mortality rate of 35% that had occurred in the control matched group of patients. Also, better control of intracranial pressure (ICP) had occurred in patients in which a DC surface was made larger than 40ccm. In addition, less computed tomography (CT) scans were made as a follow up care procedure in patients in which DC procedure was performed and especially if DC procedure had been performed within 24 hours after the injury. However, regardless of many positive results that an early application of DC procedure has had on SBI patients with TSDH, an expected increase in immediate or delayed complications had occurred, for example we had recorded an increased number of encefalocele. Significantly better outcome of clinical recovery with less cases of morbidity and deaths had occurred in patients in which TSDH was removed with the DC technique within 24 hours after the time of injury and also if a DC surface had had size over 40 ccm, in compari- son to the group of patients that had TSDH removed with DC technique within longer period of time than 24 hours after the time of injury and also better than the control group.

Clinical and medicolegal characteristics of neck injuries.

The predominance in performing surgery of major spine injuries by neurosurgeons usually has the consequence of treating all types of spine injuries by neurosurgeons - neurotraumatologists. In the neurosurgical wards of Clinical Hospital Rijeka, we take care of the majority of these patients, following both the major, as well as minor--whiplash injuries of the neck. This article is an overview of the patients admitted in the one year period (October 1st 2009-October 1st 2010) where 1077 cases of neck injuries were analyzed. Vast majority of these injuries were due to traffic accidents (over 94%), and only a small proportion were serious injuries that needed a surgical approach--decompression and stabilization (c1%). We analyzed minor neck injuries thoroughly both because of the increasing number of whiplash neck injuries and because more complicated diagnostic and therapeutic protocols occupy too much time in the ambulatory practice of our neurotraumatologists each year thus representing a growing financial burden to the health organizations and to the society as a whole. Our results proved that the majority of the injured are male (over 60%), young and active (almost two thirds 21-40 years of age), had commonly sustained a Quebec Task Force (QTF) injury of grades 2 and 3 (almost 90%), and, if properly treated, recovered completely after a mean therapy period of ten weeks. Only a minority complained of prolonged residual symptoms, some of them connected with medico-legal issues (less than 20%). The results shown are in contrast with the general opinion that malingerers in search of financial compensation prevail in these cases, and leads to the conclusion that minor neck injuries (including whiplash) as well as Whiplash Associated Disorder (WAD) are real traumatological entities, that have to be seriously dealt with.

Efficancy of decompressive craniectomy in treatment of severe brain injury at the Rijeka University Hospital Centre.

Decompressive Craniectomy (DC) is a treatment option for severe brain injury (SBI). This method is applied when the growth of intracranial pressure (ICP) can no longer be controlled with conservative methods. DC belongs to class III "Guidelines"--"option" which has not clear clinical certainty. They do not correspond to "Standards" (class I) in treatment protocol for SBI, which is common in most neurotraumatological centers. We have analyzed retrospectively 95 patients with SBI who were admitted to the Clinical Hospital Centre Rijeka. All patients were managed based on a protocol of current Brain Trauma Foundations (BTF) Guidelines. 39 patients underwent DC while 34 patients underwent standard craniotomy. 22 patients did not undergo any surgical procedures. In each patient we analyzed ICP changes within the first 11 days and in that way we correlated them statistically with the initial Glasgow Coma Scale (GCS) and then with Glasgow Outcome Scale (GOS), after the end of the treatment. We particularly analyzed the outcome with reference to the time of the operation and the size of DC. The standard measurement of ICP shows statistical significance in recovery in the group without DC after 5 days of intensive treatment, when the pressure is stabilized between 20-25 mm Hg. The stabilization of ICP in the DC group is observed already after 3 days of intensive treatment. Furthermore, better functional recovery according to GOS, which is statistically significant, was observed in patients who underwent DC where the area of craniectomy was larger than 25 cm2, within the first 24 hours from the time of injury. The use of DC considerably reduces the need for CT check-ups. Increase in the number of encephalocele was noted, which is to be expected considering that dural decompression is used in DC procedure. The results of our study indicate that the utilization of DC is characterized with lower mortality and better functional recovery if it is applied at an early stage of treatment and if the size of DC is satisfactory.