Usefulness of the DN4, S-LANSS and painDETECT screening questionnaires to detect the neuropathic pain components in people with acute whiplash-associated disorders: A cross-sectional study.

OBJECTIVE: Although the presence of neuropathic pain (NP) components has been reported in whiplash-associated disorders (WAD), no studies have analyzed the usefulness of NP screening questionnaires to detect NP components in WAD. This study aimed to assess the usefulness of three screening NP tools (Douleur Neuropathique 4 [DN4], self-administered Leeds Assessment of Neuropathic Symptoms and Signs [S-LANSS], and painDETECT questionnaire [PDQ]) to detect the presence of NP components in acute WAD. DESIGN: A cross-sectional study. SETTING: Hospital. SUBJECTS: Of 188 eligible individuals, fifty people (68% women, mean age = 40.3 ± 12.5 years) with acute WAD (52% Grade III) were included. METHODS: Specialized physicians initially screened participants for the presence of NP components according to clinical practice and international recommendations. After physician assessment, blinded investigators assessed participants using NP screening questionnaires (DN4, S-LANSS, PDQ) within 2 weeks of accident. Diagnostic accuracy of these tools was analyzed and compared to the reference standard (physicians' assessments). RESULTS: : The three screening questionnaires showed excellent discriminant validity (area under the curve [AUC] ≥ 0.8), especially S-LANSS (AUC : 0.9; p < 0.001). DN4 demonstrated the highest sensitivity (87%) followed by S-LANSS (75%), while S-LANSS and PDQ showed the highest specificity (85% and 82%, respectively). These tools demonstrated a strong correlation with the reference standard (S-LANSS: Rho = 0.7; PDQ: Rho = 0.62; DN4: Rho = 0.7; all, p < 0.001). CONCLUSIONS: The DN4, S-LANSS and PDQ show excellent discriminant validity to detect the presence of NP components in acute WAD, especially S-LANSS. Initial screening with these tools might improve management of WAD.

Efficacy of early versus delayed spinal cord decompression in neurological recovery after traumatic spinal cord injury: Systematic review and meta-analysis. / Eficacia de la descompresión medular precoz versus tardía en la recuperación neurológica tras lesión medular traumática. Revisión sistemática y metaanálisis.

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To compare early (<24h) versus late (>24h) spinal cord decompression on neurological recovery in patients with acute spinal cord injury. METHODS: A systematic review was performed according to the PRISMA protocol to identify studies published up to December 2022. Prospective cohort studies and controlled trials comparing early versus delayed decompression on neurological recovery were included. Variables included number of patients, level of injury, treatment time, ASIA grade, neurological recovery, use of corticosteroids, and complications. For the meta-analysis, the «forest plot¼ graph was developed. The risk of bias of the included studies was assessed using the ROBINS-I22 and Rob223 tools. RESULTS: Six of the seven studies selected for our review were included in the meta-analysis, with a total of 1188 patients (592 patients in the early decompression group and 596 in the delayed decompression group), the mean follow-up was 8 months, in 5 studies used methylprednisolone, the most reported complications were thromboembolic cardiopulmonary events. Five studies showed significant differences in favor of early decompression (risk difference 0.10, 95% confidence interval 0.07-0.14, heterogeneity 46%). The benefit was greatest in cervical and incomplete injuries. CONCLUSION: There is scientific evidence to recommend early decompression in the first 24h after traumatic spinal cord injury, as it improves final neurological recovery, and it should be recommended whenever the patient and hospital conditions allow it to be safely done.

Outcomes of spinal cord injury following cervical fracture in ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis (DISH): A prospective cohort study / Lesión medular cervical traumática en pacientes afectados de espondilitis anquilosante y DISH. Estudio comparativo prospectivo

Introduction The ankylosed spine is prone to increased fractures risk even after minor trauma. The lower cervical spine is most frequently injured, and fractures of the ankylosed spine tend to precipitate spinal cord injury (SCI). The objective of the current study is to assess the incidence, management, and outcomes of patients with ankylosis of the spine sustaining a cervical fracture with associated SCI over a 7-year period. Material and methods Prospective cohort study. Patients referred to the institution with a cervical fracture associated with SCI on a background of AS or DISH from 2009 to 2017 were reviewed. Demographics, mechanism of injury, fracture type, neurological level of injury, time to surgery, surgical management, neurological status (AIS), spinal cord independence measure (SCIMIII) scale at admission and discharge, and hospital length of stay. In September 2019 the summative data was analyzed using NDI, VAS, SV-QLI/SCI and length of survival were analyzed for statistical significance. Pathological fractures and dementia were excluded. Results 1613 patients with traumatic SCI were admitted in this period of whom 37 (12 AS and 25 DISH) met the inclusion criteria (mean age 65 years AS; 67 DISH). Fracture-dislocation was the most frequent fracture type (33% AS patients, 24% DISH patients). C4 was the most common neurological level of injury. SCIMIII score at admission was 1 point and 59 at discharge. AIS at admission was A (50%). At time of discharge no patient had neurologically deteriorated. Post-discharge mortality was 58% in AS patients and 32% in DISH patients (p=0.13).ConclusionsBoth AS and DISH patients have high levels of disability and mortality associated with trauma to the cervical spine... (AU)

Introducción Los pacientes afectados de espondiloartropatías son susceptibles de fracturas cervicales ante un traumatismo de baja energía, siendo la lesión medular una posible complicación devastadora. El objetivo del presente estudio es describir y evaluar la evolución de la lesión medular de estos pacientes con un seguimiento medio de 7 años. Material y métodos Estudio analítico longitudinal de cohortes prospectivo de pacientes afectados de espondiloartropatías ingresados en nuestro centro en el periodo del 2009 al 2017. Criterios de inclusión: diagnóstico de espondilitis anquilosante (EA) o hiperostosis idiopática difusa (DISH), fractura cervical, presencia de lesión medular. Ingreso en nuestro centro en el postoperatorio inmediato y edad superior al diagnóstico de 18 años. La presencia de demencia o fractura patológica se catalogaron como criterios de exclusión. Se han evaluado las variables de interés: edad, sexo, número de pacientes afectados de EA, DISH, mecanismo energético, tipo de fractura, tiempo hasta la cirugía, tipo de cirugía realizada, SCIM III ingreso/alta, nivel de lesión cervical, ASIA ingreso/alta, tiempo estancia, seguimiento en años. En septiembre del 2019 fueron nuevamente evaluados en consultas externas mediante: cuestionario de discapacidad cervical (NDI), escala visual analógica numérica, cuestionario de calidad de vida validado en castellano para lesionados medulares (QLI) y análisis de la supervivencia. Resultados Mil seiscientos trece pacientes afectados de lesión medular ingresaron en nuestro centro en el periodo de estudio, de los cuales 37 pacientes (12 EA y 25 DISH) cumplían los criterios de inclusión con una edad media de 65 años (EA) y de 67 años (DISH). La fractura luxación fue el tipo de fractura más prevalente (33% EA, 24% DISH). El nivel neurológico de lesión más prevalente tras la fractura cervical fue C4. El SCIM III al ingreso fue de 1 punto y de 59 puntos al alta. La escala ASIA al ingreso fue ASIA... (AU)

Outcomes of spinal cord injury following cervical fracture in ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis (DISH): A prospective cohort study.

INTRODUCTION: The ankylosed spine is prone to increased fractures risk even after minor trauma. The lower cervical spine is most frequently injured, and fractures of the ankylosed spine tend to precipitate spinal cord injury (SCI). The objective of the current study is to assess the incidence, management, and outcomes of patients with ankylosis of the spine sustaining a cervical fracture with associated SCI over a 7-year period. MATERIAL AND METHODS: Prospective cohort study. Patients referred to the institution with a cervical fracture associated with SCI on a background of AS or DISH from 2009 to 2017 were reviewed. Demographics, mechanism of injury, fracture type, neurological level of injury, time to surgery, surgical management, neurological status (AIS), spinal cord independence measure (SCIMIII) scale at admission and discharge, and hospital length of stay. In September 2019 the summative data was analyzed using NDI, VAS, SV-QLI/SCI and length of survival were analyzed for statistical significance. Pathological fractures and dementia were excluded. RESULTS: 1613 patients with traumatic SCI were admitted in this period of whom 37 (12 AS and 25 DISH) met the inclusion criteria (mean age 65 years AS; 67 DISH). Fracture-dislocation was the most frequent fracture type (33% AS patients, 24% DISH patients). C4 was the most common neurological level of injury. SCIMIII score at admission was 1 point and 59 at discharge. AIS at admission was A (50%). At time of discharge no patient had neurologically deteriorated. Post-discharge mortality was 58% in AS patients and 32% in DISH patients (p=0.13). CONCLUSIONS: Both AS and DISH patients have high levels of disability and mortality associated with trauma to the cervical spine. Despite their distinct clinical differences, in this cohort there were no statistically significant differences between AS and DISH patients regarding fracture type, SCIMIII, AIS, hospital stay, mortality, VAS, and SV-QLI/SCI after cervical fracture over 7 years follow-up.

Neuropathological and Motor Impairments after Incomplete Cervical Spinal Cord Injury in Pigs.

Humans, primates, and rodents with cervical spinal cord injury (SCI) show permanent sensorimotor dysfunction of the upper/forelimb as consequence of axonal damage and local neuronal death. This work aimed at characterizing a model of cervical SCI in domestic pigs in which hemisection with excision of 1 cm of spinal cord was performed to reproduce the loss of neural tissue observed in human neuropathology. Posture and motor control were assessed over 3 months by scales and kinematics of treadmill locomotion. Histological measurements included lesion length, atrophy of the adjacent spinal cord segments, and neuronal death. In some animals, the retrograde neural tracer aminostilbamidine was injected in segments caudal to the lesion to visualize propriospinal projection neurons. Neuronal loss extended for 4-6 mm from the lesion borders and was more severe in the ipsilateral, caudal spinal cord stump. Axonal Wallerian degeneration was observed caudally and rostrally, associated with marked atrophy of the white matter in the spinal cord segments adjacent to the lesion. The pigs showed chronic monoplegia or severe monoparesis of the foreleg ipsilateral to the lesion, whereas the trunk and the other legs had postural and motor impairments that substantially improved during the first month post-lesion. Adaptations of the walking cycle such as those reported for rats and humans ameliorated the negative impact of focal neurological deficits on locomotor performance. These results provide a baseline of behavior and histology in a porcine model of cervical spinal cord hemisection that can be used for translational research in SCI therapeutics.

«El convento de las monjas torcidas». Síndrome de Pisa y camptocormia inducido por antipsicóticos / “The bent nuns convent”. Antipsycotic-induced Pisa Syndrome and Camptocormia

La camptocormia y el sídrome de Pisa (pleurothotonus) se caracteriza por una postura anormal en el tronco, con una flexión de la columna toracolumbar de entre 15-45° durante la bipedestación y la marcha que se corrige completamente con el decúbito supino. Se asocia a la enfermedad de Parkinson y a otras enfermedades neurodegenerativas, siendo su fisiopatología incierta. Se presentan 3 casos de camptocormia secundaria a antipsicóticos atípicos (AU)

Camptocormia is an involuntary flexion between 15-45° of the thoracolumbar spine when standing, walking or sitting, which disappears completely in the supine position. Is associated to Parkinson's disease and other neurodegenerative conditions, being its physiopatology unknown. We report three cases of atypical anti-psychotic induced camptocormia (AU)

"The bent nuns convent". Antipsycotic-induced Pisa Syndrome and Camptocormia. / «El convento de las monjas torcidas¼. Síndrome de Pisa y camptocormia inducido por antipsicóticos.

Camptocormia is an involuntary flexion between 15-45° of the thoracolumbar spine when standing, walking or sitting, which disappears completely in the supine position. Is associated to Parkinson's disease and other neurodegenerative conditions, being its physiopatology unknown. We report three cases of atypical anti-psychotic induced camptocormia.

Spanish Version of the Whiplash Disability Questionnaire in Adults With Acute Whiplash-Associated Disorders.

OBJECTIVE: The purpose of this study was to develop and validate a Spanish version of the Whiplash Disability Questionnaire (WDQ) for the Spanish population with acute whiplash-associated disorder (WAD). METHODS: This was a cross-sectional questionnaire validation study. Adults with acute WAD (grade I to III) were enrolled within 3 weeks of their injury. A blinded forward and back translation of the WDQ was made from English to Spanish, and the resulting back-translation version was compared with the original. Patients with WAD completed the Spanish version of the 13-item WDQ. The developed questionnaire was assessed using psychometric statistical analysis including correlation with the numerical rating score for pain, Northwick Park Neck Pain Questionnaire, Neck Disability Index, and 36-item Short Form Health Survey. RESULTS: Fifty-six patients completed the questionnaire, the mean age was 33.9 years (standard deviation [SD] = 10.5), and 76.8% were women. Participants were enrolled 13.9 days (SD 4.9) after the injury, with 14.3% presenting with WAD grade I and 85.7% with WAD grade II. The mean WDQ score was 62 (SD = 31). Two factors were detected, and the factor structure remained stable after translation. Positive correlations were identified between the total WDQ score and the numerical rating score, Neck Pain Questionnaire, and Neck Disability Index results, with a strong negative correlation with the 36-item Short Form Health Survey. CONCLUSION: The Spanish version of WDQ is psychometrically reliable and a valid instrument to measure the disability status in patients with acute WAD within the clinic.

Deficient Inhibitory Endogenous Pain Modulation Correlates With Periaqueductal Gray Matter Metabolites During Chronic Whiplash Injury.

OBJECTIVES: This study examined predictive correlations between periaqueductal gray (PAG) and anterior cingulate cortex (ACC) metabolite levels with deficient inhibitory endogenous pain modulation (EPM), including sensory and affective measures of pain during chronic whiplash injury (WHI). MATERIALS AND METHODS: Healthy patients, and participants with chronic WHI, without (WHI-noP) or with pain (WHI-P), were screened with the Douleur Neuropathique 4 tool (DN4). EPM was assessed with C6 tonic heat pain stimuli with a Conditioned Pain Modulation (CPM) protocol. Magnetic resonance spectroscopy quantified ACC and PAG metabolite levels. RESULTS: WHI-P participants were characterized with high pain intensity and interference, and lower quality of life scores, compared with WHI-noP. Inhibitory CPM at 30 seconds was identified in the healthy noninjured (-45±16%; P<0.001) and WHI-noP groups (-36±8%; P<0.001). However, inhibitory EPM was not detected in the WHI-P group (-25±15%; P=0.06). Best fit and stepwise multiple regression revealed that the PAG glutamate/myoinositol metabolite ratio (P=0.01) and total creatine levels (P=0.02) predicted loss of EPM in the WHI-P group (r=0.71, α=0.97). Although myoinositol predicted loss of EPM in the ACC (P=0.04), this was below statistical power (r=0.31; α=0.56). The ACC N-acetyl-aspartate/myoinositol ratio (P=0.006) predicted chronic pain (DN4, r=0.53; α=0.87). DISCUSSION: The results of this study demonstrate deficient EPM at 30 seconds during tonic heat pain stimulation in WHI-P participants, compared with noninjured healthy volunteers or individuals with WHI-noP. In addition, quantification of PAG and ACC metabolites related to glutamate and glia predicted central chronic pain mechanisms related to loss of inhibitory EPM, while ACC metabolites characterized chronic pain described by descriptors and sensory changes.

Hernia intraesponjosa de Schmörl sintomática / Symptomatic intraosseous Schmörl herniation

Las hernias discales intraesponjosas vertebrales o nódulos de Schmörl consisten en una herniación o una extrusión del núcleo pulposo del disco intervertebral a través del platillo vertebral hacia el cuerpo adyacente. Suelen asociarse a deformidades vertebrales, como la enfermedad de Scheuermann, o a enfermedades reumáticas, como la espondilitis anquilopoyética. En general, son hallazgos casuales y cuadros asintomáticos; son pocos los casos publicados de nódulos sintomáticos. Su aparición estaría relacionada con un platillo vertebral debilitado por traumatismo o estrés repetido. Cuando el nódulo es agudo o reciente, puede ser difícil diferenciar la degeneración benigna de una infiltración maligna o una infección. Presentamos un caso inusual de un nódulo de Schmörl doloroso en un hombre sin antecedentes de relevancia, que enmascaró una lesión metastásica de carcinoma pancreático a nivel lumbar. Se realiza una revisión bibliográfica. Nivel de Evidencia: IV

Intraosseous disc herniation -or Schmörl nodes (SN)- are a herniation or prolapse of the nucleus pulposus of the intervertebral disc through the vertebral plate and into the adjacent vertebral body. They are usually associated with vertebral deformities, such as Scheuermann's disease, or rheumatic diseases, such as ankylopoietic spondylitis. In general, they are spontaneous and asymptomatic findings, and there are only a few reported cases of symptomatic nodes. The etiology is supposedly related to a weakened spinal plate due to trauma or repeated stress. When the node is acute or recent, it can be difficult to differentiate a benign degeneration from a malignant infiltration or infection. In this paper, we discuss the unusual case of a painful Schmörl node in a man with no relevant history and a masked metastatic lumbar spinal tumor originated from pancreatic cancer. We performed a literature review. Level of Evidence: IV

Utilidad de la ultrasonografía en el diagnóstico de dolor de codo secundario a plica sinovial / Utility of ultrasonography in the diagnosis of elbow´s pain secondary to synovial plica

Introducción: El dolor en el epicóndilo lateral del codo es uno de los síntomas clínicos más frecuentes en la extremidad superior. La presencia de la plica sinovial como causa de chasquido doloroso en el codo fue descrito por primera vez por Clarke. Esta plica es una estructura anatómica normal, remanente del desarrollo embriológico de la membrana articular sinovial, pero cuando ésta se encuentra engrosada, es una causa potencial de dolor de codo. Caso clínico: Se presenta el caso clínico de un varón de 42 años, médico traumatólogo, sin antecedente de interés, con dominancia derecha, que practica de forma habitual el pádel y el golf. Diagnosticado de epicondilitis pero sin respuesta al tratamiento conservador durante 9 meses y tras estudio mediante ecografía y RM se objetiva la presencia de una plica sinovial en el codo, que mediante artroscopia se extirpó con buenos resultados. Discusión: La plica sinovial en el codo suele estar infradiagnosticada por tratarse de una entidad poco conocida para el clínico, lo que dificulta el diagnóstico diferencial. Además debido a las características del proceso, que produce escasos signos subjetivos y objetivos, suele etiquetarse erróneamente como epicondilitis lateral rebelde al tratamiento. Para conseguir los mejores resultados en el alivio del dolor y la recuperación de la funcionalidad articular, se debe descartar patología asociada y el tratamiento quirúrgico debe ir acompañado de una rehabilitación específica. Conclusión: La presencia de plica sinovial en el codo es una causa de dolor de codo habitualmente mal diagnosticada. La ultrasonografía es una herramienta útil para el diagnóstico de esta entidad (AU)

Introduction: Lateral elbow pain is one of the most common pain syndromes of the upper extremity. The presence of synovial fold or radial fringe as the cause of painful snapping elbow was first described by Clarke. This plica is a normal anatomic structure, embryological development like remaining articular synovial membrane, but when it is thickened, is a potential cause elbow pain. Case report: The case of a 42 year old male, orthopedic doctor has no history of interest, right dominance, practicing regularly paddle, tennis and golf. He was diagnosed as radial epicondylitis, but with no response to the conservatory management. Ultrasound and MR imaging found the presence of synovial fold in the elbow. This fold was removed arthroscopically, and resulting in pain relief. Discussion: The synovial fold in the elbow is often under diagnosed because it is a little known, making it difficult differential diagnosis. Also due to the characteristics of the process that produces few subjective and objective signs, often erroneous labeled as lateral epicondylitis resistant to treatment. For best results in relieving pain and recovery of joint function, exclude associated pathology and surgical treatment should be accompanied by a specific rehabilitation. Conclusion: The presence of synovial plica in the elbow is one of the most under-diagnosed causes of a painful elbow. The ultrasound is a useful tool for the diagnosis of this entity (AU)

Identifying patients with chronic low back pain likely to benefit from lumbar facet radiofrequency denervation: a prospective study.

STUDY DESIGN: Case series. Prospective study. OBJECTIVE: This is a prospective study of a group of patients with chronic low back facet joint pain, meticulously selected using a combination of clinical history, examination, imaging tests, and lumbar facet joint block with a local anesthetic, aimed at assessing the efficacy of treatment with percutaneous rhizolysis in reducing pain and improving related disability. SUMMARY OF BACKGROUND DATA: Percutaneous radiofrequency facet joint denervation (rhizolysis) provides significant alleviation of pain and functional disability in patients with chronic low back pain of facet joint origin. However, accurate patient selection represents a clinical challenge. Patient selection based only on the result of diagnostic blocks may lead to disappointing results as the false-positive rate of the anesthetic diagnostic blocks is reported to be more than 30%. METHODS: A total of 86 patients (mean age, 49.87; mean duration of pain, 7.12 y) finally selected for treatment with rhizolysis were those who presented with chronic lumbar pain and a clinical history and examination with characteristics specific to facet joint pain; whose imaging tests ruled out a possible origin of pain other than the facet joints; and who finally responded favorably to facet joint block with a local lumbar anesthetic. All patients were clinically evaluated according to the indications of the Spanish Society for the Study of Diseases of the Spine (GEER). A follow-up of a minimum of 1 year was conducted. RESULTS: After rhizolysis, lumbar pain, measured by the visual analog scale and the Oswestry Low Back Pain Disability Questionnaire, improved significantly (P<0.05), with the reduction in disability due to lumbar pain being reflected in a notable improvement in the patients' quality of life. A total of 89% of patients experienced significant relief from pain after rhizolysis, with this relief lasting 6 months or more in 66%, and a minimum of 1 year in 50% of cases. At 1 year, 75.67% of patients stated that they would willingly undergo the same treatment again. CONCLUSIONS: Rhizolysis is a valuable tool for the symptomatic treatment of chronic lumbar facet joint pain. A meticulous selection of patients using a combination of clinical history, examination, imaging tests, and lumbar facet joint block with a local anesthetic, achieves long-lasting results by helping reduce the impact on these patients' daily activities.

Tratamiento sintomático del deportista amateur con lumbalgia crónica mecanodegenerativa mediante denervación facetaria por radiofrecuencia (rizolisis) / Radiofrecuency facet joint denervation (Rhizotomy) for the symptomatic treatment of the amateur sportmen and women with chronic degenerative low back pain

Objetivo: Evaluar la validez y eficacia del tratamiento mediante denervación percutánea facetaria lumbar por radiofrecuencia (rizolisis), en pacientes jóvenes que presentan dolor lumbar crónico de origen facetario asociado a la práctica deportiva. Material y método: Estudio prospectivo realizado entre Julio del 2005 y Febrero del 2007, con 42 pacientes sometidos arizolisis por lumbalgia crónica de origen facetaria asociada a la práctica deportiva de más de tres meses de evolución, que no habían mejorado con tratamiento conservador. Pacientes valorados clínicamente según la Sociedad Española para el Estudio de las Enfermedades del Raquis (GEER). Edad media de 34,53 años. Duración media del dolor 3,46 años. Seguimiento mínimo de un año. Resultados: Tras la rizólisis, el dolor lumbar medido mediante Escala Analógica Visual (EAV) y el cuestionario Owestry de discapacidad (ODI) mejoran significativamente (p<0,05) reflejando una notable mejoría en su calidad de vida al disminuir su incapacidad por el dolor lumbar. El 93,33% de los pacientes experimenta alivio significativo del dolor tras rizolisis, llegando a ser superior o igual a seis meses en el 70%. Al año, el 83,33%de los pacientes afirman que volverían a someterse al mismo tratamiento. Casi todos los pacientes han podido reanudar sus actividades deportivas favoritas. Conclusiones: El deportista amateur que más consulta por dolor lumbar crónico es un varón entre 30-40 años. El retraso entre la aparición de los síntomas y la solicitud de consulta especializada podría indicar una gran tolerancia a los síntomas por parte del paciente deportista. La rizolisis es una valiosa herramienta para el tratamiento sintomático del dolor lumbar crónico de origen facetario. Una meticulosa selección de los pacientes mediante la combinación de la clínica, exploración, pruebas por imagen y bloqueo anestésico facetario, obtienen resultados duraderos en el tiempo ayudando a disminuir el impacto sobre la actividad cotidiana de estos pacientes (AU)

Objective: Prospective study aimed at assesing the efficacy and validity of treatment with percutaneous radiofrequency lumbar denervation (rhizolysis) in a group of patients with chronic low back facet joint pain due to sports activities. Materials and methods: From July 2005 to February 2007, 42patients underwent rhizolysis for chronic low back facet joint pain of over three months’ evolution, associated with sports activities, and resistant to conservative treatment. Patients(mean age, 34.53 years; and mean duration of pain, 3.46 years)were clinically evaluated as per the indications of the Spanish Society for the Study of Diseases of the Spine (Sociedad Española para el Estudio de las Enfermedades del Raquis - GEER).A follow-up of a minimum of one year was conducted. Results: Following rhizolysis, lumbar pain, measured by the Visual Analogue Scale (VAS) and the Owestry Low Back Pain Disability Questionnaire (ODQ), improved significantly (p<0.05), with the reduction in disability due to lumbar pain being reflected in a notable improvement in patients’ quality of life. A total of 93.33% of patients experienced significant relief from pain after rhizolysis, with this relief lasting six months or more in 70% of cases. At one year, 93.33% of patients stated that they would willingly undergo the same treatment again. Almost all patients reported being able to renew their favourite sports activities. Conclusions: The most likely patient presenting with low back pain related to a sporting activity will be an amateur sportman between 30 and 40 years of age. The delay between the onset of symptoms and first consultation reflects the resistance of sportmen and sportwoman to symptoms. Rhizolysis is a valuable tool for symptomatic treatment of chronic lumbar facet joint pain. A meticulous selection of patients using a combination of clinical history, examination, imaging tests and lumbar facet joint block with local anaesthetic, achieves long lasting results by helping reduce the impact on these patients’ daily activities (AU)

Aplicación de la ecografía tridimensinal en el diagnóstico de las lesiones musculoesqueléticas / Application of the three-dimensional ultrasound scand to the diagnosis of musculoseskeletal injures

Con el fin de aumentar la precisión en el diagnóstico y tratamiento de las lesiones músculo esqueléticas, especialmente en el ámbito del deporte, se hace necesario la inclusión de nuevas aplicaciones tecnológicas de la ultrasonografía. Entre las nuevas aplicaciones que con carácter de portabilidad pueden mejorar la exactitud en el diagnóstico de lesiones que afectan a estos tejidos blandos se encuentra la imagen armónica (Tissue harmonic image: THI), la técnica de imagen ampliada, que permite obtener una visión panorámica de los tejidos y el sistema de ecografía compuesta en tiempo real que aumenta notablemente la resolución lateral de la imagen (Sistema Compound) mejorando la capacidad de estos aparatos compactos, especialmente en aquellas lesiones que afectan a los planos más profundos. Pero sin duda lo que puede suponer un gran avance en la visualización e interpretación de las lesiones que afectan a los tejidos músculo esqueléticos es la ecografía en tres dimensiones (3D).Se compara en este estudio la visualización de dos tipos diferentes de lesiones (lesión de una bolsa sinovial y de un cartílago) con dos técnicas ultrasónicas como es la ecografía standart en 2 dimensiones y el estudio tridimensional (3D), describiendo las diferencias en las imágenes obtenidas con cada uno de estos modos. Con el fin de unificar los criterios de valoración de la imagen, en este trabajo se han propuesto unos indicadores y parámetros cuantitativos de calidad ecográfica, en la zona de la lesión, comparando las imágenes de la lesión obtenidas por ambos modos. Ante la presencia de una lesión de contenido líquido como la bursitis, la valoración multiplanar permite estudiar con mucho detalle la forma de la estructura líquida asegurando la precisión del tratamiento ecográfico intervencionista. Por otra parte, cuando se trata de una lesión que afecta al cartílago, se definen con gran exactitud los límites de la destrucción condral, pudiéndose de esta forma, precisar mucho más el diagnóstico, el pronóstico y la actitud terapéutica (AU)

In order the precision increases in the diagnosis ad treatment of the musculoskeletal injuries, specially in the area of the sport traumatology,there becomes necessary the incorporation of new technological applications of the ultrasonography. Among the new applications that with character of portability can improve the accuracy in the diagnosis of musculo skeletal injuries finds the harmonic image (Tissue harmonic image: THI), the technology of extended image, which allows to obtain a panoramic vision of the tissue and the Real-Time Spatial Compound Sonography that increases notably the lateral resolution of the image (System Compound) improving the capacity of these compact devices, specially in those injuries that concern the deepest planes. But undoubtedly what can suppose a great advance in the visualization and interpretation of the injuries that concern the músculo esqueléticos injuries is the ultrasound scan in three dimensions (3D). In this study is compared the visualization of two types different from injuries (Injury of a bursal fluid collection and of a injury cartilage) with two ultrasonic technologies like it is the standart two dimensional ultrasound (2D) and the three-dimensional study (3D), describing the differences in the images obtained with each of these types. In order to unify the criteria of valuation of the image, in this study we have proposed a few indicators and quantitative parameters of ultrasound quality, in the area of the injury, comparing the images obtained by both manners. Before the presence of an injury of liquid content as the bursal fluid collection, the ultrasound 3D allows to study with very much detail the form of the liquid structure assuring the precision of sonographically guided therapy. On the other hand, when it is an injury that it concerns the cartilage, the condral injury is observed accurately, being able of this form, add much more the diagnosis, evolution and the therapeutic attitude (AU)

¿Qué es el "clavo" del pelotari? / What is the "nail" in pelota basque players?

OBJETIVO: valorar la lesión conocida como "clavo", estableciendo su etiología para poder así conocer cómo prevenirla y tratarla.-INTRODUCCIÓN: la pelota vasca se encuentra principalmente difundida en las Comunidades de Navarra, País Vasco y La Rioja, así como en el sur de Francia y algunos países Americanos. El "clavo o iltzia" corresponde a un dolor puntiforme, profundo y no irradiado, localizado en la base de los 2°, 3° y 4° dedos de la mano de los pelotaris manomanistas que impide la práctica deportiva. -MATERIAL Y MÉTODO: estudio prospectivo de las manos de 15 pelotaris varones afectos de "clavo". El protocolo consistió en un cuestionario, examen físico, radiografías en proyecciones anteroposterior y oblicua, ecografía de ambas manos y resonancia magnética de la mano dominante.-RESULTADOS: se localizaron 25 puntos dolorosos con las características de "clavo" en la mano dominante y 5 en la no-dominante. Encontramos hematomas en el tejido celular subcutáneo en 9 de esos puntos, coincidiendo con aquellas lesiones más dolorosas y de larga evolución. Además existían cambios difusos en la grasa subcutánea en 17 puntos y leves alteraciones de los tendones flexores en 4. Los hallazgos de ecografía y resonancia magnética son concordantes. En las radiografías no se detectaron alteraciones relacionadas con la zona del dolor. -CONCLUSIONES: el "clavo" es una lesión traumática del tejido celular subcutáneo consistente en la formación de hematomas que resultan dolorosos; hay que incidir en su prevención mediante la correcta colocación de las protecciones, la potenciación de la musculatura intrínseca y de la formación del callo cutáneo, y el calentamiento exhaustivo de las manos antes del partido; la ecografía es el método con mejor coste-beneficio tanto para el diagnóstico como el seguimiento de la lesión y debería evitarse la reincorporación al deporte hasta que el cuadro se encuentre resuelto (AU)