[Winter sports injuries of the thoracic and lumbar spine : Etiology, classification and stage-specific therapy]. / Wintersportverletzungen der Wirbelsäule : Ätiologie, Klassifikation und stadiengerechte Therapie.

BACKGROUND: Overall, spinal injuries in winter sports are extremely rare. The incidence is given as approximately 0.01/1000 ski days. While falls and collisions at high speed are the main concerns for skiers, spinal injuries for snowboarders occur primarily on landing after a jump. The age of a typical spinally injured skier is 40, which is older than that of the average snowboarder at 23. CLASSIFICATION: Primarily, the thoracolumbar junction is injured and hereby mainly anterior compression fractures (type A1) and burst fractures (types A3 and A4) occur. Injuries caused by flexion or distraction mechanisms (Type B) or rotation injuries (Type C) are less common. Injuries to the cervical spine are rare overall, but they are also represented in the very few cases with neurological deficits. THERAPY: With appropriate X­ray diagnostics, including CT and, if necessary, MRI, the appropriate therapy can be initiated so that a return to sport is possible in most cases. Furthermore, there is ongoing scientific discussion as to when conservative therapy is superior and when surgery is superior.

Robot-Aided Minimally Invasive Lumbopelvic Fixation in Treatment of Traumatic Spinopelvic Dissociation.

OBJECTIVE: To investigate the surgical strategy, safety, and efficacy of close reduction and robot-aided minimally invasive lumbopelvic fixation in treatment of traumatic spinopelvic dissociation. METHODS: Data of 32 patients (21 males and 11 females) with traumatic spinopelvic dissociation treated by lumbopelvic fixation with robot-aided minimally invasive technique or conventional open procedure in our institution from March 2010 to April 2019 were retrospectively analyzed, and divided into robot group and control group. Intraoperative blood loss, surgical time, fluoroscopy frequency, total drilling times, infection rate, hospitalization time, and sacral fracture healing time were reviewed. Radiographs and computed tomography (CT) scans were totally acquired to evaluate the reduction quality, residual fracture displacement, and Gras classification on screws insertion after surgery. According to the Majeed scoring system, functional outcome was assessed for each patient at the final follow-up. RESULTS: There were 12 patients in the robot group and 20 patients in the control group with no significant difference about the demographic data. The average surgical time was 148.3 ± 40.5 min with intraoperative blood loss of 142.5±36.7 mL in the robot group and 185.0 ± 47.8 min with 612.5 ± 182.7 mL in the control group (P = 0.034, P = 0.000). The robot group had a shorter mean hospitalization time at 19.9 ± 7.0 days compared to the control group with 28.6 ± 5.4 days (P = 0.010). The fluoroscopy frequency was 35.4 ± 3.0 in the robot group and 45.5 ± 3.6 in the control group (P = 0.000) and total drilling times were 7.1 ± 1.1 and 9.6 ± 1.3 (P = 0.000), respectively. The infection rate was 0% (0/12) in the robot group and 15% (3/20) in the control group (P = 0.159). According to the Gras classification on screw positioning, there were 11 cases in Grade I and 1 case in Grade II in the robot group, and 14 cases in Grade I and 6 cases in Grade II in the control group. All the patients were followed up consecutively for at least 12 months, with an average follow-up period of 17.1 ± 3.6 months. All sacral fractures healed with an average time of 3.8 ± 0.6 months in the robot group and 4.7 ± 0.7 months in the control group (P = 0.000). According to Majeed functional assessment investigation, the mean score of the patients was 87.2 ± 4.0 in the robot group and 83.1 ± 4.5 in the control group (P = 0.015). CONCLUSIONS: Robot-aided minimally invasive lumbopelvic fixation for traumatic spinopelvic dissociation is a safe and feasible option with advantages of less intraoperative blood loss, less radiation damage, less hospitalization time, and better functional outcome.

Dynamic Response of the Thoracolumbar and Sacral Spine to Simulated Underbody Blast Loading in Whole Body Post Mortem Human Subject Tests.

Fourteen simulated underbody blast impact sled tests were performed using a horizontal deceleration sled with the aim of evaluating the dynamic response of the spine in under various conditions. Conditions were characterized by input (peak velocity and time-to-peak velocity for the seat and floor), seat type (rigid or padded) and the presence of personnel protective equipment (PPE). A 50% (T12) and 30% (T8) reduction in the thoracic spine response for the specimens outfitted with PPE was observed. Longer duration seat pulses (55 ms) resulted in a 68-78% reduction in the magnitude of spine responses and a reduction in the injuries at the pelvis, thoracic and lumbar regions when compared to shorter seat pulses (10 ms). The trend analysis for the peak Z (caudal to cranial) acceleration measured along the spine showed a quadratic fit (p < 0.05), rejecting the hypothesis that the magnitude of the acceleration would decrease linearly as the load traveled caudal to cranial through the spine during an Underbody Blast (UBB) event. A UBB event occurs when an explosion beneath a vehicle propels the vehicle and its occupants vertically. Further analysis revealed a relationship (p < 0.01) between peak sacrum acceleration and peak spine accelerations measured at all levels. This study provides an initial analysis of the relationship between input conditions and spine response in a simulated underbody blast environment.

Effectiveness and safety of warm needle acupuncture on lumbar muscles strain: A protocol for systematic review and meta analysis.

BACKGROUND: Lumbar muscle strain (LMS) is the most common orthopedic syndrome, with high incidence globally and lingering disease, which seriously affects patients' work efficiency and quality of life. Warm needle acupuncture (WNA) is a treatment method combining acupuncture technology with warm and medicinal effect of moxibustion. It has outstanding curative effect and wide range of treatment, especially in the treatment of pain diseases. We aim to collect clinical evidence and demonstrate the efficacy and safety of WNA on LMS. METHODS/DESIGN: We will search the following database sources for the randomized controlled trials: PubMed, Cochrane Library, Excerpta Medica Database (EMBASE), Web of Science, WHO International Clinical Trials Registry Platform (TCTRP), Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure Database (CNKI), Chinese Scientific Journals Database (VIP), and the Wanfang Database.All randomized controlled trials of WNA for lumbar muscle strain (LMS) in the above database will be considered for inclusion, and high-quality articles will be screened for data extraction and analysis, to summarize the therapeutic effect of WNA on LMS patients. RESULT: This study will provide a rational synthesis of current evidences for warm needle acupuncture on lumbar muscle strain. CONCLUSION: The conclusion of this study will provide evidence to judge the effectiveness and safety of WNA on LMS. TRIAL REGISTRATION: INPLASY2020120100 (DOI number: 10.37766/inplasy2020.12.0100).

Treatment outcomes of peri-articular steroid injection for patients with work-related sacroiliac joint pain and lumbar para-spinal muscle strain.

OBJECTIVES: Evaluating treatment outcomes of local corticosteroid injections for work-related lower back pain (LBP) as the current evidence for the American College of Occupational and Environmental Medicine guidelines is considered insufficient to recommend this practice. MATERIAL AND METHODS: The authors conducted a retrospective study involving the patients who were treated with peri-articular and lower lumbar corticosteroid injections for work-related LBP at their occupational medicine clinic. RESULTS: Sixty-four patients met the inclusion criteria. The average pain level was reduced from M±SD 5.1±2.0 to M±SD 3.1±2.3 after the corticosteroid injection (p < 0.0001). Thirty-five patients (55%) were discharged to regular duty; 23 (36%) were transferred to orthopedics due to persistent pain; and 6 (9%) were lost to follow-up. CONCLUSIONS: Corticosteroid injections for work-related LBP are effective in reducing pain and enhancing discharge to regular duty. Nonetheless, larger prospective trials are needed to validate these findings. Int J Occup Med Environ Health. 2021;34(1):111-20.

Wrist ankle acupuncture in the treatment of acute lumbar sprain: A protocol for systematic review and meta-analysis.

BACKGROUND: Acute lumbar sprain (ALS) frequently occurs in the young and middle-aged people, causing great harm to people's quality of life. The systematic review program was designed to describe a meta-analysis to evaluate the efficacy and safety of wrist-ankle acupuncture (WAA) in treating patients with ALS. METHODS AND ANALYSIS: Our systematic review will search electronically and manually for WAA treatments for ALS by August, 2020, regardless of publication status and language. Databases include: MEDLINE, PubMed, EMBASE, Springer, Web of Science, Cochrane Library, WHO International Clinical Trial Registration Platform (ICTRP), Chinese Medicine Database (TCMD), China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), China Science Journal Database (VIP), and Wanfang Database. Other sources of information, including bibliographies and meeting minutes for identified publications, will also be searched. Manually search for grey literature, including unpublished conference articles. Any clinical randomized controlled trials related to WAA treatments for ALS, regardless of publication status and language limitations, will be included in the study. Study selection, data extraction, and research quality assessment will be done independently by 2 researchers. The primary outcome included the effective rate and visual analogue scale (VAS) or other validated scales used to relieve pain after the treatment. If possible, meta-analysis will be performed using RevMan V.5.3 statistical software. If it is not suitable for meta-analysis, a descriptive analysis or subgroup analysis is performed. RESULTS: This study will provide a comprehensive review and evaluation of the available evidence for the treatment of ALS using WAA. CONCLUSION: This study will provide new evidence to evaluate the effectiveness and side effects of WAA on ALS. Because the data is not personalized, no formal ethical approval is required. REGISTRATION NUMBER: PROSPERO CRD42020162945.

Epidemiology of injury and illness in 153 Australian international-level rowers over eight international seasons.

AIM: To report the epidemiology of injury and illness in elite rowers over eight seasons (two Olympiads). METHODS: All athletes selected to the Australian Rowing Team between 2009 and 2016 were monitored prospectively under surveillance for injury and illness. The incidence and burden of injury and illness were calculated per 1000 athlete days (ADs). The body area, mechanism and type of all injuries were recorded and followed until the resumption of full training. We used interrupted time series analyses to examine the association between fixed and dynamic ergometer testing on rowers' injury rates. Time lost from illness was also recorded. RESULTS: All 153 rowers selected over eight seasons were observed for 48 611 AD. 270 injuries occurred with an incidence of 4.1-6.4 injuries per 1000 AD. Training days lost totalled 4522 (9.2% AD). The most frequent area injured was the lumbar region (84 cases, 1.7% AD) but the greatest burden was from chest wall injuries (64 cases, 2.6% AD.) Overuse injuries (n=224, 83%) were more frequent than acute injuries (n=42, 15%). The most common activity at the time of injury was on-water rowing training (n=191, 68). Female rowers were at 1.4 times the relative risk of chest wall injuries than male rowers; they had half the relative risk of lumbar injuries of male rowers. The implementation of a dynamic ergometers testing policy (Concept II on sliders) was positively associated with a lower incidence and burden of low back injury compared with fixed ergometers (Concept II). Illness accounted for the greatest number of case presentations (128, 32.2% cases, 1.2% AD). CONCLUSIONS: Chest wall and lumbar injuries caused training time loss. Policy decisions regarding ergometer testing modality were associated with lumbar injury rates. As in many sports, illness burden has been under-recognised in elite Australian rowers.

A systematic review and meta-analysis for Chinese herbal medicine Duhuo Jisheng decoction in treatment of lumbar disc herniation: A protocol for a systematic review.

BACKGROUND: Lumbar disc herniation (LDH) is 1 of the most common diseases in orthopedics, which seriously affects people's daily life and brings a heavy burden on society and families. Chinese herbal medicine has been used in clinical practice for a long time and Duhuo Jisheng Decoction (DHJSD) is believed to help alleviate the symptoms of LDH. This systematic review aims to collect evidences from randomized clinical trials and evaluate the efficacy of DHJSD on LDH in order to provide a reference for clinicians and researchers. METHODS: We will comprehensively search the 8 electronic databases until December 2019 to identify related randomized controlled trials, including 4 foreign databases (PubMed, MEDLINE, EMBASE, Cochrane Library) and 4 Chinese databases (China National Knowledge Infrastructure Database, VIP Database, Wanfang Database and China Biology Medicine disc). The data of the World Health Organization International Clinical Trial Registry Platform and the Chinese Clinical Trial Registry also will be searched. The primary outcomes are Japanese Orthopaedic Association scores and visual analog scale scores. The risk of bias will be assessed using the Cochrane Collaboration tool. RevMan (V.5.3) software will be used for meta-analysis. RESULTS: This study will report the results of DHJSD for the treatment of LDH from the literature screening, the basic information of the included studies, the risk of bias of the included studies, treatment effects, safety, and so on. CONCLUSION: This systematic review will evaluate the effectiveness and safety of DHJSD for the treatment of LDH and provide the latest evidence for its clinical application. ETHICS AND DISSEMINATION: This is a literature-based study, therefore it does not require ethical approval. PROSPERO REGISTRATION NUMBER: CRD42019147302.

Gender Differences in Surgery for Work-Related Musculoskeletal Injury: A Population-Based Cohort Study.

OBJECTIVE: The objective of this study is to examine if women are less likely than men to receive surgery following work-related musculoskeletal injury in the Canadian province of British Columbia. METHODS: The study included 2,403 workers with work-related knee meniscal tear, thoracic/lumbar disc displacement or rotator cuff tear. Probability of surgery was compared by gender using Kaplan-Meier methods and Cox proportional hazards models. RESULTS: For each injury type, a smaller proportion of women received surgery compared to men (knee: 76% vs. 80%; shoulder: 13% vs. 36%; back: 13% vs. 19%). In adjusted models, compared to men, women were 0.87 (95% confidence interval [CI] [0.69, 1.09]), 0.35 (95% CI [0.25, 0.48]) and 0.54 (95% CI [0.31, 0.95]) times less likely to receive knee, shoulder or back surgery, respectively. CONCLUSIONS: Probability of surgery following work-related musculoskeletal injury was lower for women than for men. Strategies to ensure gender equitable delivery of surgical services by workers' compensation systems may be warranted, although further research is necessary to investigate determinants of the gender difference and the impact of elective orthopaedic surgery on occupational outcomes.

Lumbar Juxtafacet Cysts.

AIM: To evaluate the factors affecting the clinical and radiological findings of juxtafacet cyst patients. MATERIAL AND METHODS: Between January 2011 and December 2018, eight patients diagnosed with juxtafacet cyst were reviewed, retrospectively. Patient demographics; signs and symptoms; and neurological examination, radiological, and surgical findings were noted. RESULTS: The mean age was 54 years (range, 34â€"69 years) with five (62.5%) females and three (37.5%) males. There were nine juxtafacet cysts in eight patients. Five cysts (55.5%) were located at the L3â€"L4 level, two cysts (22.2%) at the L4â€"L5 level, and two cysts (22.2%) at the L5â€"S1 level. In all patients with L3â€"L4 cysts, the intercrest line was intersecting the spinal column at L4 vertebral body level. The most frequent symptoms were back pain and radiculopathy. Magnetic resonance imaging and computerized tomography revealed degenerative facet arthropathy in six patients (75%). Three patients (37.5%) had a medical history of trauma. One patient (12.5%) was treated conservatively. Seven patients (87.5%) were advised to undergo surgical treatment. CONCLUSION: Degeneration and instability are the main causes of juxtafacet cysts. They are mainly seen at the L4â€"L5 level due to higher movement capacity of this level. But, if the intercrest line intersects the spinal column at higher levels, degeneration and instability risks move to upper levels, and juxtafacet cysts may occur at the L3â€"L4 or upper levels.

Are Hip Physical Examination Findings Predictive of Future Lower-Body Injury Rates in Elite Adolescent Female Soccer Athletes at Minimum 5-Year Follow-Up?

CONTEXT: Although elite adolescent female soccer athletes have unique injury risk factors and management challenges, limited epidemiological data exist for this population. OBJECTIVE: To describe lower-body injury patterns and to determine whether a screening hip physical examination is predictive of future injuries in elite adolescent female soccer athletes. DESIGN: Prospective cohort study. SETTING: One US premier soccer club. PARTICIPANTS: One hundred seventy-seven female soccer athletes aged 10-18 years (mean [SD] 14.6 [1.8] y) completed a demographic questionnaire and screening hip physical examination that included range of motion and provocative tests. INTERVENTIONS: At least 5 years after baseline screening, athletes completed an electronic follow-up injury survey. Injury was defined as pain that interfered with sporting activity. MAIN OUTCOME MEASURES: In addition to descriptive analyses of athletes' injury profiles, associations between players' baseline demographics and subsequent injury profiles were evaluated using chi-square tests, and potential predictors of injury based on players' baseline hip examinations were evaluated using multivariable logistic regression. RESULTS: Ninety-four of 177 athletes (53%) were contacted for follow-up, and 88/94 (93.6%) completed the survey. With mean follow-up of 91.9 (9.3) months (range 66-108 mo), 42/88 (47.7%) reported sustaining a new lower-body injury. The low back was the most common injury region (16/42, 38.1%). Almost half of all injured athletes (20/42, 47.6%) sustained overuse injuries, and 16/42 (38.1%) had an incomplete recovery. Higher body mass index and reaching menarche were associated with sustaining an injury (P = .03 and .04, respectively). Athletes' baseline hip examinations were not predictive of their subsequent rate of lower-body, lumbopelvic, overuse, or incomplete recovery injury (all P > .05). CONCLUSIONS: Lower-body injuries were common in elite adolescent female soccer athletes, with over one third of injured athletes reporting permanent negative impact of the injury on their playing ability. Baseline hip physical examinations were not associated with future injury rate.

Is there an association between external workload and lower-back injuries in cricket fast bowlers? A systematic review.

OBJECTIVE: To examine the level of evidence for an association between external bowling workload and lower-back injuries in cricket fast bowlers. METHODS: Six online databases were searched using four sets of keywords (relating to cricket, bowler, lumbar, workload). Risk of bias was assessed using the NIH quality assessment tool, while quality of evidence was assessed according to the Cochrane Back and Neck (CBN) group guidelines. RESULTS: Eight articles were found to fit the inclusion/exclusion criteria. It was found that overall, there was a low quality of evidence amongst the included studies. A high risk of bias was present - both in the measurement of external workload and lower-back injuries. CONCLUSION: The association between external workload and lower-back injuries has minimal strength. Technological advancements that allow total workload to be measured accurately would potentially allow the association between workload and lower-back injury to be examined more precisely, possibly leading to effective injury prevention interventions in fast bowlers.

Effects of a Progressive Stabilization Exercise Program Using Respiratory Resistance for Patients with Lumbar Instability: A Randomized Controlled Trial.

BACKGROUND This study investigated the effects of progressive stabilization exercise program carried out with respiratory resistance in patients with lumbar instability. MATERIAL AND METHODS Forty-three patients with lumbar instability were randomly assigned to experimental (n=20) and control groups (n=23). The experimental group performed progressive lumbar stabilization exercises along with respiratory resistance, and the control group only performed progressive lumbar stabilization exercises, for 40 min per session, 3 sessions a week, for 4 weeks. Numeric rating scale (NRS), Korean-Oswestry disability index (K-ODI), static balance ability, Fear-Avoidance Beliefs Questionnaire (FABQ), and pulmonary function test (PFT) were performed before and after the intervention program for comparison. RESULTS The 2 groups showed significant differences in NRS, K-ODI, balance ability, and FABQ after the interventions (p<0.05), but greater improvements were shown by the experimental group in balance ability and FABQ values. PFT results in the experimental group showed a significant increase (p<0.05) in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and maximum voluntary ventilation (MVV). The experimental group showed a greater improvement (p<0.05) in FVC and MVV compared to the control group. CONCLUSIONS Progressive stabilization exercise program with respiratory resistance is an effective method with clinical significance in pain reduction, psychosocial stability, and enhancement of motor and respiratory functions.

The Effectiveness and Safety of Utilizing Mobile Phone-Based Programs for Rehabilitation After Lumbar Spinal Surgery: Multicenter, Prospective Randomized Controlled Trial.

BACKGROUND: Rehabilitation is crucial for postoperative patients with low back pain (LBP). However, the implementation of traditional clinic-based programs is limited in developing countries, such as China, because of the maldistribution of medical resources. Mobile phone-based programs may be a potential substitute for those who have no access to traditional rehabilitation. OBJECTIVE: The aim of this study was to examine the efficacy of mobile phone-based rehabilitation systems in patients who underwent lumbar spinal surgery. METHODS: Patients who accepted spinal surgeries were recruited and randomized into 2 groups of rehabilitation treatments: (1) a mobile phone-based eHealth (electronic health) program (EH) or (2) usual care treatment (UC). The primary outcomes were (1) function and pain status assessed by the Oswestry Disability Index (ODI) and (2) the visual analog scale (VAS). Secondary outcomes were (1) general mental health and (2) quality of life (Likert scales, EuroQol-5 Dimension health questionnaire, and 36-item Short-Form Health Survey). All the patients were assessed preoperatively and then at 3, 6, 12, and 24 months postoperatively. RESULTS: A total of 168 of the 863 eligible patients were included and randomized in this study. Our analysis showed that the improvement of primary outcomes in the EH group was superior to the UC group at 24 months postoperatively (ODI mean 7.02, SD 3.10, P<.05; VAS mean 7.59, SD 3.42, P<.05). No significant difference of primary outcomes was found at other time points. A subgroup analysis showed that the improvements of the primary outcomes were more significant in those who completed 6 or more training sessions each week throughout the trial (the highest compliance group) compared with the UC group at 6 months (ODI mean 17.94, SD 5.24, P<.05; VAS mean 19.56, SD 5.27, P<.05), 12 months (ODI mean 13.39, SD 5.32, P<.05; VAS mean 14.35, SD 5.23, P<.05), and 24 months (ODI mean 18.80, SD 5.22, P<.05; VAS mean 21.56, SD 5.28, P<.05). CONCLUSIONS: This research demonstrated that a mobile phone-based telerehabilitation system is effective in self-managed rehabilitation for postoperative patients with LBP. The effectiveness of eHealth was more evident in participants with higher compliance. Future research should focus on improving patients' compliance. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR-TRC-13003314; http://www.chictr.org.cn/showproj.aspx?proj=6245 (Archived by WebCite at http://www.webcitation.org/766RAIDNc).

Pneumocephalus: a rare and life-threatening, but reversible, complication after penetrating lumbar injury.

Pneumocephalus, the presence of intracranial air, is a complication especially seen after neurotrauma or brain surgery. When it leads to a pressure gradient, a so-called tension pneumocephalus, it may require emergency surgery. Clinical symptomatology, especially in young children, does not differentiate between a pneumocephalus and a tension pneumocephalus. An additional CT scan is therefore warranted. Here, we report on a rare case of pneumocephalus after penetrating lumbar injury. Additionally, the pathophysiology of pneumocephalus, as well as its recommendations for diagnosis and treatment, will be elucidated.

Quantifying the lumbar spine movements of surgeons during surgical lists in a teaching hospital.

BACKGROUND: Low back pain (LBP) is a common occupational musculoskeletal complaint among health professionals. No research has quantified lumbar movement patterns in the surgical workplace, identifying 'at risk' behaviours with objective measures. This project aimed to identify lumbar movement patterns and change in LBP of surgeons and surgical trainees during a surgical list. METHODS: Surgeons or surgical trainees were recruited in a tertiary metropolitan hospital. Low back movements were quantified in real time via a monitoring system. This measured three-dimensional movement, velocity, acceleration and orientation to gravity during a typical theatre session. Pre- and post-surgery LBP, or low back injury measures of functional disability were quantified using the Oswestry disability index. Mean (standard deviation) and median (interquartile range) low back movement patterns were described. A Wilcoxon signed-rank test determined differences in LBP recorded from beginning to end of recording periods. RESULTS: Participants (n = 28) recorded data for a mean (standard deviation) of 6.1 (2.2) h. On average, 27.7 lumbar flexion events were recorded per monitoring session, with flexion movements held for >30 s an average of 5.6 times. Many of the flexion events were considered low range (between 20° and 40°) with an average of 19.1 events per session. Orthopaedic trainees recorded the highest average of lumbar and sustained lumbar flexions per hour (4.13 times). LBP significantly increased over the work day (z = -2.53, P = 0.012). CONCLUSION: This study provides a base for the understanding of low back movement patterns during surgery. This data may be useful in helping surgeons to identify their 'high risk' movements and prevent low back symptoms.