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1.
Medicine (Baltimore) ; 100(9): e24535, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655920

RESUMO

OBJECTIVE: To establish whether early use of magnetic resonance imaging (MRI) or computed tomography (CT) influences treatment and outcome of patients with low back pain. METHODS: This study will be implemented from March 2021 to March 2022 at Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University. The experiment was granted through the Research Ethics Committee of Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University (R609320987). Patients who have symptomatic lumbar spine disorders at presentation are eligible for the trial if there is clinical uncertainty about the need for imaging (MRI or CT). Patients are excluded who required immediate referral for imaging (those who had signs suggestive of serious abnormalities or disease or who required surgical intervention), who have undergone MR imaging or CT of the spine within 1 year, who do not need imaging, and who have pain of a nonspinal origin. The primary outcome measure is the Aberdeen Low Back Pain (ALBP) score. Other principal outcome measure is the Short Form 36. RESULTS: Table 1 will show the quality of life outcome measures between groups. CONCLUSION: This study may guide the policy makers to develop an evidence-based protocol to assess the effect of early use of MRI or CT in the treatment of patients with low back pain.


Assuntos
Tomada de Decisão Clínica/métodos , Dor Lombar/diagnóstico por imagem , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Precoce , Feminino , Humanos , Dor Lombar/terapia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
3.
Turk Neurosurg ; 31(1): 119-123, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33372261

RESUMO

AIM: To compare the efficacies of fluoroscopy- and ultrasound (US)-guided caudal epidural steroid injections (CESIs) in patients with chronic low back pain (LBP). MATERIAL AND METHODS: This study included patients with chronic LBP who underwent US- (Group U; n = 90) or fluoroscopyguided (Group F; n = 90) CESI. The procedure time, successful injection rate on the first attempt, complication rate, Oswestry Disability Index (ODI) score, and Numeric Rating Scale (NRS) score before CESI and after 3 weeks and 3 months of CESI were analyzed. RESULTS: NRS and ODI scores improved at 3 weeks (p < 0.001) and 3 months (p < 0.001) after CESIs. No significant differences were noted between the two groups for the NRS (p=0.22 and p=0.47) and ODI (p=0.58, p=0.22) scores. Moreover, the CESI procedure time was significantly shorter (p < 0.001) and the successful injection rate on the first attempt was significantly higher (p=0.002) in Group U than in Group F. The complication rate difference was statistically insignificant between the two groups (p > 0.05). CONCLUSION: Outcomes of US-guided CESI were superior than those of fluoroscopy-guided CESI considering the successful injection rate on the first attempt and procedure time. In addition, US-guided CESI was as effective as fluoroscopy-guided CESI and did not expose patients and practitioners to radiation.


Assuntos
Anestesia Epidural/métodos , Dor Crônica/diagnóstico por imagem , Dor Crônica/tratamento farmacológico , Dor Lombar/diagnóstico por imagem , Dor Lombar/tratamento farmacológico , Adulto , Idoso , Anestesia Epidural/normas , Feminino , Fluoroscopia/métodos , Fluoroscopia/normas , Seguimentos , Humanos , Injeções Epidurais/métodos , Injeções Epidurais/normas , Monitorização Neurofisiológica Intraoperatória/métodos , Monitorização Neurofisiológica Intraoperatória/normas , Masculino , Pessoa de Meia-Idade , Esteroides/administração & dosagem , Ultrassonografia/métodos , Ultrassonografia/normas
4.
Niger J Clin Pract ; 23(11): 1530-1535, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33221777

RESUMO

Background: Globally, low back pain (LBP) is now the leading cause of disability. Patients often have lumbar spine motion dysfunction (motion decrease/increase), and this may affect the lumbar lordosis (LL). Though the relationship between LL and LBP is controversial, it has immense clinical significance, because it serves as the basis of therapeutic exercises for treating and preventing LBP. An angular measure of LL that consistently detects even a small lordotic change (LC) would be considered reliable. Aims and Objectives: The consistency of some radiographic angles in detecting LC in a potential LBP disorder was evaluated, and LC fulcrum deducted. Materials and Methods: In both normal (control) and spondylotic (test) lateral lumbosacral radiographs of both genders, LL was retrospectively measured using the following angular measures and sample sizes: Lumbosacral angle (LSA, 125), Lumbosacral joint angle (LSJA, 115), Cobb angle (118), and Tangential radiologic assessment of lumbar lordosis (TRALL) angle (101). The angles' consistency in detecting intra-gender LC between control versus test was evaluated. The intervertebral disc (IVD) that sub-tended the most consistent angle represents the LC fulcrum. All cases were ≥17 years of age. Data was analyzed with IBM SPSS Statistics 23.0 (NY, USA); P < 0.05 was considered statistically significant. Results: LSJA detected slight intra-gender LC in both genders, LSA in males only, Cobb and TRALL angles in none. The IVD of L5/S1 sub-tended the LSJA and therefore represents the LC fulcrum. Conclusion: LSJA is a reliable measure of lumbar LC in physical therapy of LBP, especially, the non-specific LBP disorders.


Assuntos
Lordose/diagnóstico por imagem , Dor Lombar/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Região Lombossacral/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Lordose/fisiopatologia , Vértebras Lombares/fisiopatologia , Região Lombossacral/fisiopatologia , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos
5.
Medicine (Baltimore) ; 99(38): e22198, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957350

RESUMO

Consistency between back pain intensity and degenerative changes on magnetic resonance imaging (MRI) of the lumbar spine is poor. This study aimed to show whether tender point (TP) examination, used as a test for diffuse central sensitization, may add valuable information to clinical assessment of patients with low back pain (LBP).This was a cross-sectional study including 141 patients with LBP on sick leave. Baseline measures comprised back pain, leg pain intensity, and LBP examination including TP examination. Degenerative MRI findings were assessed in a standardized manner and blinded for clinical data. The number of TPs was analyzed in relation to sex, widespread pain, radiculopathy, pain duration, and degenerative changes on MRI.The number of TPs was positively associated with the female sex, widespread pain, and pain duration. It was negatively associated with degenerative manifestations and radiculopathy, the latter displaying a low level similar to that of the general population. A positive association between back pain intensity and TPs was present in patients with and without radiculopathy and in patients with substantial degenerative changes. Men with >7-8 TPs and women with >10-11 TPs had more back pain and similar or fewer degenerative changes than patients with few TPs (<3 and <6 TPs, respectively), thereby identifying 34% to 44% of patients with nonspecific LBP and 5% to 8% of patients with radiculopathy, respectively, with disproportionate back pain in relation to degenerative changes.Supplemental TP examination improved clinical and MRI evaluation of patients with LBP. By using gender-specific cut points, patients with disproportionate back pain were identified, presumably indicating diffuse central sensitization.


Assuntos
Sensibilização do Sistema Nervoso Central , Dor Crônica/complicações , Hiperalgesia/diagnóstico , Dor Lombar/complicações , Adulto , Estudos Transversais , Feminino , Humanos , Hiperalgesia/etiologia , Dor Lombar/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tato
6.
Spine (Phila Pa 1976) ; 45(15): 1047-1054, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32675607

RESUMO

STUDY DESIGN: Retrospective observational cohort study. OBJECTIVES: To compare the benefits of long and short fusion treatments, and to identify factors potentially aiding surgeons' decision making about the surgical management of degenerative lumbar scoliosis associated with spinal stenosis (DLSS). SUMMARY OF BACKGROUND DATA: The comparative effectiveness of long and short segment fusion for the treatment of DLSS remains controversial. METHODS: Fifty-three patients with symptomatic DLSS managed by posterior-only fusion surgery were enrolled in this study. Twenty patients underwent short fusion (fewer than two segments), and 33 patients had more than three segments fused. The radiological outcomes were assessed by radiography. Health-related quality of life data, including visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, were collected at all preoperative and follow-up visits. RESULTS: The short and long fusion groups showed significant differences in the change in the Cobb angle (4.2° vs. 11.2°), lumbar lordosis (3.9° vs. 11.5°), and pelvic incidence minus the lumbar lordosis angle (PI - LL; 3.2° vs. 11.2°). Both the short and long fusion achieved significant changes in low back pain and leg pain. Patients with PI -LLs > 10° had more relief of low back pain after long fusion (VAS 4.0 ±â€Š2.0) than after short fusion (VAS 2.6 ±â€Š1.7). Patients with PI - LLs > 10° showed significantly improved walking ability after long fusion (ODI 1.0 ±â€Š0.8). The improvement in standing ability after short fusion was greater when PI - LL ≤ 10°(ODI 0.9 ±â€Š0.6). CONCLUSION: Long segment fusion can relieve low back pain better and improve walking ability when PI-LL is mismatched, whereas short segment fusion is more advantageous in improving standing ability in cases of more balanced sagittal spinopelvic alignment. LEVEL OF EVIDENCE: 3.


Assuntos
Lordose/cirurgia , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Ossos Pélvicos , Escoliose/cirurgia , Estenose Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Gerenciamento Clínico , Feminino , Humanos , Lordose/diagnóstico por imagem , Dor Lombar/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/diagnóstico por imagem , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Fusão Vertebral/métodos , Fusão Vertebral/tendências , Estenose Espinal/diagnóstico por imagem , Resultado do Tratamento
7.
Pain Physician ; 23(4): 383-392, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709173

RESUMO

BACKGROUND: Transforaminal (TF) lumbar injection is a commonly used minimally invasive intervention for management of chronic low back pain. TF injection can be performed using various approaches to inject the drug to the anterior epidural space (AES). OBJECTIVES: To identify the volumes of contrast medium needed to reach the AES and other landmarks in the Kambin triangle (KB) and subpedicular (SP) approach of TF injection in patients with lumbosacral radicular pain. STUDY DESIGN: Randomized controlled trial. SETTING: Pain clinic and operating room of a tertiary care hospital. METHODS: Seventy-five eligible patients were randomized to receive TF epidural injection either by SP (SP group; n = 38) or the KB (KB group; n = 37) approach under fluoroscopic guidance. After confirming the appropriate needle position, contrast medium was injected at 0.5 mL increments up to 2 mL under intermittent fluoroscopy. Contrast medium volumes needed to reach specific landmarks, that is, AES, medial to superior pedicle, medial to inferior pedicle, medial aspect of both the superior, and neural spread, were recorded. Following this, 4 mL of the drug (0.5% lidocaine 1 mL + methylprednisolone 80 mg + 1 mL normal saline solution) was injected. Patients were evaluated for Visual Analog Scale (VAS) and modified Oswestry Disability Questionnaire (MODQ) scores after epidural injections at 2 weeks, 1 month, and 2 months. RESULTS: Average volume of contrast medium needed to reach AES was 1.10 ± 0.46 mL in the KB approach and 1.10 ± 0.38 mL in the SP approach. Contrast medium volume needed to reach other landmarks showed comparable results in both groups. AES was seen in 27.02% (10/37) patients in the KB group and 23.6% (9/38) patients in the SP group with 0.5 mL of contrast medium. This increased to 56.76% (21/37) and 77.7% (28/38) with 1 mL of contrast medium (P = 0.03, chi-square test). No anterior spread was seen even after 2 mL of contrast medium in 4 patients in the KB group and 2 patients in the SP group. Neural spread was seen in 100% of patients in the KB group after 0.5 mL of contrast medium, but in 34 (89.4%) patients in the SP group (P = 0.03, chi-square test). We did not note any contralateral spread. Short-term effectiveness in pain relief in terms of VAS for back pain and functional improvement in terms of MODQ score over time showed similar results in both groups. Intravascular needle puncture and needle paresthesia was comparable in both groups. LIMITATIONS: Small follow-up duration is one the limitations of this study. Future studies will be needed to assess any long-term differences in outcome between approach methods. Also, use of intermittent fluoroscopy might have limited detection of intravascular injections of the contrast medium in comparison to the continuous fluoroscopy. CONCLUSIONS: To conclude, our study revealed that average volume of contrast medium needed to reach AES and other landmarks were comparable with both approaches of TF injection. KEY WORDS: Transforaminal injection, subpedicular approach, Kambin triangle approach, contrast medium spread, anterior epidural spread.


Assuntos
Meios de Contraste/administração & dosagem , Espaço Epidural/efeitos dos fármacos , Espaço Epidural/diagnóstico por imagem , Dor Lombar/diagnóstico por imagem , Dor Lombar/tratamento farmacológico , Manejo da Dor/métodos , Adulto , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Injeções Epidurais/métodos , Lidocaína/administração & dosagem , Masculino , Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Escala Visual Analógica
8.
J Ayub Med Coll Abbottabad ; 32(2): 234-237, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584000

RESUMO

BACKGROUND: Lumbosacral transitional vertebra is a common anatomical variant of the spine that possibly is related to low back pain. The objective is to determine the frequency of Lumbosacral Transitional Vertebrae on lumbosacral radiographs in patients with low back pain visiting Neurosurgery OPD of Khyber Teaching Hospital Peshawar Khyber Pakhtunkhwa (KP). METHODS: This cross-sectional study was conducted on radiographs of lumbosacral spine in patients visiting for low back pain to the Neurosurgery OPD of Khyber Teaching Hospital Peshawar. A total of 300 anteroposterior (AP) and lateral lumbosacral plain radiographs were studied for the variation in lumbosacral spinal segment. The transition was classified according to the scheme used by Castellvi. RESULTS: Among a total of 300 patients, normal anatomy of lumbosacral segments was observed in 215 patients (72%). About 85 cases (28%) showed Lumbosacral Transitional Vertebrae. The relationship of vertebral variation with age and gender was not observed. With regard to morphology, 29 (34.1%) patients had Castellvi type I, 26 cases (30.5%) were observed with Castellvi type II and 12 patients (14.1%) had type III while 18 cases (21.2%) had type IV transitional morphology. CONCLUSIONS: Lumbosacral Transitional Vertebrae are commonly found in patient with low back pain. Identification of Lumbosacral Transitional Vertebrae is clinically important to prevent an intervention at an incorrect vertebral level.


Assuntos
Dor Lombar/diagnóstico por imagem , Vértebras Lombares , Sacro , Estudos Transversais , Humanos , Dor Lombar/cirurgia , Vértebras Lombares/anormalidades , Vértebras Lombares/diagnóstico por imagem , Procedimentos Neurocirúrgicos , Paquistão , Radiografia , Sacro/anormalidades , Sacro/diagnóstico por imagem
10.
Clin Imaging ; 66: 1-6, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32413808

RESUMO

We report a case of symptomatic Oppenheimer ossicle in an 18-year-old male who presented with back pain. L5 pars interarticularis defect was suspected on initial lumbar spine radiographs. A subsequent technetium99m-methylene diphosphonate (Tc99m-MDP) bone scintigraphy with single-photon emission computed tomography/computed tomography (SPECT/CT) revealed focal radiotracer uptake in an Oppenheimer ossicle in L2 vertebra. CT was negative for pars defect. Oppenheimer ossicle is a developmental variant resulting from an unfused accessory ossification center at the tip of the articular process. It is important to recognize this entity as a rare cause of low back pain. Focal tracer uptake can mimic changes from pars interarticularis defect on planar and SPECT images. SPECT/CT helps to resolve both entities. To our knowledge, this is also the first report in English literature describing a symptomatic Oppenheimer ossicle on a bone scan.


Assuntos
Dor Lombar/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Adolescente , Adulto , Difosfonatos , Fraturas Ósseas , Humanos , Dor Lombar/etiologia , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Radiografia , Tomografia Computadorizada de Emissão de Fóton Único/métodos
11.
Praxis (Bern 1994) ; 109(6): 425-432, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-32345187

RESUMO

Imaging for Non-Specific Low Back Pain According to 'Smarter Medicine' - a Survey from Three General Practices Abstract. We examined how the recommendation of "smarter medicine"/Switzerland for diagnostic imaging of nonspecific lumbar back pain is implemented in three general practices. METHOD: Retrospective analysis of 228 conventional X-ray images of the lumbar spine from three general practices. RESULTS: Overall, about 75 % of the X-rays performed within six weeks after onset of pain were consistent with "smarter medicine" recommendations. Unsatisfactory pain improvement despite analgesics and/or physiotherapy was the most common reason for non-indicated (36.6 %), red flags [trauma (33.3 %), malignancy (19.5 %), osteoporosis (14.9 %)] for indicated (64.4 %) examinations. Per ten years of age, the probability of a non-indicated radiograph decreased by 20 % (p = 0.003). CONCLUSION: Three out of four conventional X-ray images of the lumbar spine were performed according to the recommendations of "smarter medicine" in the three practices. The further promotion of 'smarter medicine' is crucial to avoid unnecessary diagnostic or therapeutic interventions and to save costs.


Assuntos
Medicina Geral , Dor Lombar , Humanos , Dor Lombar/diagnóstico por imagem , Estudos Retrospectivos , Inquéritos e Questionários , Suíça
12.
Clin Nucl Med ; 45(6): e299-e300, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32349090

RESUMO

Low back pain with radiation to lower limbs is due to nerve root impingement or involvement in most cases. F-FDG PET/CT has shown sacral nerve root involvement in several peripheral nerve pathologies, including neurolymphomatosis, peripheral nerve sheath tumor, and plexopathies. We present 2 cases of a low back pain with ulcerative colitis and metastatic neuroendocrine tumor who underwent F-FDG PET/CT and Ga-DOTANOC PET/CT, respectively. PET/CT can be used as an adjunct tool to evaluate sacral nerve root involvement to look for malignant or inflammatory nerve involvement.


Assuntos
Colite Ulcerativa/complicações , Dor Lombar/complicações , Dor Lombar/diagnóstico por imagem , Tumores Neuroendócrinos/complicações , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Raízes Nervosas Espinhais/diagnóstico por imagem , Adulto , Feminino , Fluordesoxiglucose F18 , Humanos , Masculino , Pessoa de Meia-Idade
13.
Rozhl Chir ; 99(1): 46-50, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32122139

RESUMO

INTRODUCTION: Chronic back pain (CBP) is a very common symptom. Multiple modalities are used in its evaluation. However, according to current evidence, none of them can be used with certainty to predict the success of fusion surgery. Given the growing experience with bone tissue examination using the methods of nuclear medicine, we have used this possibility in patients with CBP without disc herniation, degenerative spinal stenosis or instability. CASE REPORTS: We present case reports of 11 patients who underwent lumbar fusion (during two years period) for degenerative disc disease or facet arthropathy with adequate activity on PET or SPECT/CT examination. Rolland-Morris Questionnaire (RMQ), Oswestry Disability Index (ODI), and Visual Analogue Scale (VAS) were filled out pre-operatively and 24 months after surgery. RESULTS: Six patients after one-level stabilization for active osteochondrosis and one for active facet arthropathy improved on average by 82% (64-92%) in RMQ, by 72% (48-100%) in ODI and 75% (55-100%) in VAS. Results in cases after multilevel stabilizations were slightly worse, but still very significant in most parameters. Only one patient with the most severe morphological and clinical findings did not benefit from surgery. CONCLUSION: In 10 out of 11 patients, the lower back pain and quality of life improved significantly after lumbar fusion performed in levels diagnosed by PET or SPECT/CT. These methods certainly have their place in the evaluation of CBP, especially in the case of unclear findings or multiple degenerative changes.


Assuntos
Dor Lombar/diagnóstico por imagem , Dor Lombar/etiologia , Dor Lombar/cirurgia , Medicina Nuclear , Fusão Vertebral , Estenose Espinal/cirurgia , Humanos , Vértebras Lombares/diagnóstico por imagem , Qualidade de Vida , Resultado do Tratamento
14.
AJR Am J Roentgenol ; 214(4): 853-861, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32069076

RESUMO

OBJECTIVE. The purpose of this article is to review the appearance of various abnormalities that affect the lumbar intervertebral disk and diskovertebral segment through anatomic-pathologic correlation in cadavers. CONCLUSION. Familiarity with the pathologic conditions in and around the intervertebral disk is important in recognizing such conditions as a potential source of symptoms. We revisit the principal role of MRI in evaluating these abnormalities and excluding other sources of significant clinical manifestations.


Assuntos
Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/patologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Imagem por Ressonância Magnética , Cadáver , Humanos , Dor Lombar/diagnóstico por imagem , Dor Lombar/patologia
16.
Med Sci Sports Exerc ; 52(7): 1495-1501, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32028457

RESUMO

PURPOSE: The primary objective of this study was to examine and compare lumbar multifidus (LM) muscle size, asymmetry, and function in university football players with and without low back pain (LBP). A secondary objective was to examine the relationship between LM characteristics and body composition in football players. METHODS: Ultrasound assessments of the LM muscle were performed in 41 university football players during the preseason. LM muscle cross-sectional area, echo intensity (e.g., indicator of fatty infiltration and connective tissue), thickness at rest, and thickness during submaximal contraction (e.g., contralateral arm lift) measurements in prone and standing positions were obtained bilaterally at the L5-S1 level. Body composition measures were acquired using dual-energy x-ray absorptiometry. A self-administered questionnaire was used to obtain LBP history data. RESULTS: The LM muscle thickness at rest in prone and in standing was significantly smaller in football players who reported the presence of LBP in the previous 3 months. The LM cross-sectional area in prone was significantly and positively correlated with weight, height, lean body mass, total fat mass, and total percent body fat. LM echo intensity was strongly correlated with total percent body fat and total fat mass and negatively correlated with the percent thickness change during contraction. CONCLUSION: The results of this study provide novel information on LM muscle morphology and activation in football players in prone and standing and suggest that players with LBP in the previous 3 months had smaller LM muscle thickness. LM morphology was strongly correlated with body composition measurements.


Assuntos
Futebol Americano/lesões , Dor Lombar/diagnóstico por imagem , Dor Lombar/patologia , Músculos Paraespinais/anatomia & histologia , Músculos Paraespinais/diagnóstico por imagem , Absorciometria de Fóton , Composição Corporal , Futebol Americano/fisiologia , Humanos , Dor Lombar/fisiopatologia , Masculino , Músculos Paraespinais/fisiologia , Decúbito Ventral , Posição Ortostática , Ultrassonografia , Estados Unidos , Adulto Jovem
18.
Sensors (Basel) ; 20(3)2020 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-32012763

RESUMO

BACKGROUND: The RGB-D camera is an alternative to asses kinematics in order to obtain objective measurements of functional limitations. The aim of this study is to analyze the validity, reliability, and responsiveness of the motion capture depth camera in sub-acute and chronic low back pain patients. METHODS: Thirty subjects (18-65 years) with non-specific lumbar pain were screened 6 weeks following an episode. RGB-D camera measurements were compared with an inertial measurement unit. Functional tests included climbing stairs, bending, reaching sock, lie-to-sit, sit-to-stand, and timed up-and-go. Subjects performed the maximum number of repetitions during 30 s. Validity was analyzed using Spearman's correlation, reliability of repetitions was calculated by the intraclass correlation coefficient and the standard error of measurement, and receiver operating characteristic curves were calculated to assess the responsiveness. RESULTS: The kinematic analysis obtained variable results according to the test. The time variable had good values in the validity and reliability of all tests (r = 0.93-1.00, (intraclass correlation coefficient (ICC) = 0.62-0.93). Regarding kinematics, the best results were obtained in bending test, sock test, and sit-to-stand test (r = 0.53-0.80, ICC = 0.64-0.83, area under the curve (AUC) = 0.55-84). CONCLUSION: Functional tasks, such as bending, sit-to-stand, reaching, and putting on sock, assessed with the RGB-D camera, revealed acceptable validity, reliability, and responsiveness in the assessment of patients with low back pain (LBP). TRIAL REGISTRATION: ClinicalTrials.gov NCT03293095 "Functional Task Kinematic in Musculoskeletal Pathology" September 26, 2017.


Assuntos
Dor Crônica/diagnóstico por imagem , Dor Lombar/diagnóstico por imagem , Amplitude de Movimento Articular/fisiologia , Gravação em Vídeo/métodos , Adolescente , Adulto , Idoso , Fenômenos Biomecânicos , Dor Crônica/diagnóstico , Dor Crônica/fisiopatologia , Avaliação da Deficiência , Feminino , Humanos , Dor Lombar/diagnóstico , Dor Lombar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Movimento , Medição da Dor , Postura/fisiologia , Adulto Jovem
19.
Med Care ; 58(2): 108-113, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31934957

RESUMO

INTRODUCTION: New low back pain (LBP) is a common outpatient complaint. Little is known about how care is delivered over the course of a year to patients who develop new LBP and whether such care patterns are guideline-concordant. METHODS: This retrospective analysis included Medicare claims of 162,238 opioid-naïve beneficiaries with new LBP from January 1, 2011, through December 31, 2014. Simple rates of modality use [computed tomography and magnetic resonance imaging (advanced imaging), physical therapy (PT), opioid and nonopioid medications] and percentiles (5th percentile, 25th percentile, median, 75th percentile, and 95th percentile) were reported. RESULTS: Within the first year, 29.4% [95% confidence interval (CI), 29.1-29.8] of patients with ≥2 visits for new LBP received advanced imaging, and 48.4% (95% CI, 47.7-49.0) of these patients received advanced imaging within 6 weeks of the first visit; 17.3% (95% CI, 17.1-17.6) of patients with ≥2 visits received PT; 42.2% (95% CI, 41.8-42.5) of patients with ≥2 visits received non-steroidal anti-inflammatory drugs (NSAIDs), 16.9% (95% CI, 16.6-17.1) received a muscle relaxant, and 26.2% (95% CI, 25.9-26.6) received tramadol; 32.3% (95% CI, 31.9-32.6) of patients with ≥2 visits received opioids; 52.4% (95% CI, 51.7-53.0) of these patients had not received a prescription NSAID, and 82.2% (95% CI, 81.7-82.7) of these patients had not received PT. CONCLUSIONS: Many patients who develop new LBP receive guideline nonconcordant care such as early advanced imaging and opioids before other modalities like PT and prescription NSAIDs.


Assuntos
Analgésicos/uso terapêutico , Dor Lombar/diagnóstico , Dor Lombar/terapia , Medicare/estatística & dados numéricos , Modalidades de Fisioterapia , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/uso terapêutico , Feminino , Humanos , Revisão da Utilização de Seguros/estatística & dados numéricos , Dor Lombar/diagnóstico por imagem , Masculino , Fármacos Neuromusculares/uso terapêutico , Padrões de Prática Médica/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
20.
J Sports Med Phys Fitness ; 60(4): 582-593, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31974334

RESUMO

BACKGROUND: Low back pain (LBP) is a common pain problem in powerlifters. There is a lack of evidence to guide powerlifters and health-care professionals in understanding the role of powerlifting in the development of LBP and treatment of injuries in powerlifters. This study aimed to describe functional impairments and patho-anatomical findings in eight powerlifters with and without LBP. METHODS: First, four powerlifters with LBP were recruited. Each powerlifter was then matched with a pain-free lifter (Control) by age, Body Mass Index and competition weight class. They all performed physical performance tests and were examined with magnetic resonance imaging. Four weeks prior to the examination the powerlifters also recorded training load. Powerlifters with LBP were also examined by a physiotherapist in order to define their pain and impairments. RESULTS: The four male powerlifters with LBP had a nociceptive pain associated with non-ideal squatting technique, higher flexibility in their lumbar spine than in their hips and patho-anatomical findings such as degenerated discs (four), spondylolysis (one) and spinal stenosis (one). However, the controls also showed similar functional impairments and patho-anatomical findings. CONCLUSIONS: Powerlifters with and without LBP show similar functional impairments and patho-anatomical findings. However, powerlifters' LBP seems associated with pain during movement and loading of the lumbar spine. The association and causation between specific functional impairments, patho-anatomical findings and LBP in powerlifters has to be further investigated in studies including more participants.


Assuntos
Atletas/estatística & dados numéricos , Traumatismos em Atletas/fisiopatologia , Dor Lombar/fisiopatologia , Adolescente , Adulto , Traumatismos em Atletas/diagnóstico por imagem , Estudos Transversais , Humanos , Dor Lombar/diagnóstico por imagem , Região Lombossacral/diagnóstico por imagem , Região Lombossacral/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Esportes , Adulto Jovem
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