Endoscopic lumbar foraminotomy.

By London Spine
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Endoscopic lumbar foraminotomy.

J Clin Neurosci. 2015 Mar 2;

Authors: Evins AI, Banu MA, Njoku I, Elowitz EH, Härtl R, Bernado A, Hofstetter CP

Abstract
Foraminal stenosis frequently causes radiculopathy in lumbar degenerative spondylosis. Endoscopic transforaminal techniques allow for foraminal access with minimal tissue disruption. However, the effectiveness of foraminal decompression by endoscopic techniques has yet to be studied. We evaluate radiographic outcome of endoscopic transforaminal foraminotomies performed at L3-L4, L4-L5, and L5-S1 on cadaveric specimens. Before and after the procedures, three dimensional CT scans were obtained to measure foraminal height and area. Following the foraminotomies, complete laminectomies and facetectomies were performed to assess for dural tears or nerve root damage. L3-L4 preoperative foraminal height increased by 8.9%, from 2.12±0.13cm to 2.27±0.14cm (p<0.01), and foraminal area increased by 24.8% from 2.21±0.18cm(2) to 2.72±0.19cm(2) (p<0.01). At L4-L5, preoperative foraminal height was 1.87±0.17cm and area was 1.78±0.18cm(2). Endoscopic foraminotomies resulted in a 15.3% increase of foraminal height (2.11±0.15cm, p<0.05) and 44.8% increase in area of (2.51±0.21cm(2), p<0.01). At L5-S1, spondylitic changes caused diminished foraminal height (1.26±0.14cm) and foraminal area (1.17±0.18cm(2)). Postoperatively, foraminal height increased by 41.6% (1.74±0.09cm, p<0.05) and area increased by 98.7% (2.08±0.17cm(2), p<0.01). Subsequent inspection via a standard midline approach revealed one dural tear of an S1 nerve root. Endoscopic foraminotomies allow for effective foraminal decompression, though clinical studies are necessary to further evaluate complications and efficacy.

PMID: 25744073 [PubMed – as supplied by publisher]

Prevalence and predictors of low bone mineral density and fragility fractures among HIV-infected patients at one Italian center after universal DXA screening: sensitivity and specificity of current guidelines on bone mineral density management.

By London Spine
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Prevalence and predictors of low bone mineral density and fragility fractures among HIV-infected patients at one Italian center after universal DXA screening: sensitivity and specificity of current guidelines on bone mineral density management.

AIDS Patient Care STDS. 2015 Apr;29(4):169-80

Authors: Mazzotta E, Ursini T, Agostinone A, Di Nicola AD, Polilli E, Sozio F, Vadini F, Pieri A, Trave F, De Francesco V, Capasso L, Borderi M, Manzoli L, Viale P, Parruti G

Abstract
Low bone mineral density (BMD) is frequent in HIV infection regardless of the use of antiretroviral therapy (ART). Uncertainties remain, however, as to when in HIV infection BMD screening should be performed. We designed a prospective study to estimate the efficacy of universal BMD screening by dual-energy X-ray absorptiometry (DXA). Since April 2009 through March 2011, HIV patients attending our Center were offered femoral/lumbar DXA to screen BMD. Low BMD for chronological age, that is significant osteopenia, was defined as a Z-score ≤ -2.0 at femur and lumbar spine. Nontraumatic bone fractures (NTBFs) were evaluated. The final sample included 163 patients. A Z-score ≤ -2.0 at any site was observed in 19.6% of cases: among these, 18.8% had no indication to DXA using current Italian HIV guidelines for BMD screening. A lower femoral Z-score was independently associated with lower BMI, AIDS diagnosis, HCV co-infection, antiretroviral treatment, and NTBFs; a lower lumbar Z-score with age, BMI, Nadir CD4 T-cell counts, and NTBFs. Prevalence of NTBFs was 27.0%, predictors being male gender, HCV co-infection, and lower femoral Z-scores. Our results suggest that measuring BMD by DXA in all HIV patients regardless of any further specification may help retrieving one-fifth of patients with early BMD disorders not identified using current criteria for selective screening of BMD.

PMID: 25692868 [PubMed – indexed for MEDLINE]

A comparison of the effect of kettlebell swings and isolated lumbar extension training upon acute torque production of the lumbar extensors.

By London Spine
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A comparison of the effect of kettlebell swings and isolated lumbar extension training upon acute torque production of the lumbar extensors.

J Strength Cond Res. 2015 Sep 25;

Authors: Luke E, James F, James S

Abstract
The aim of the present study was to use a Fatigue Response Test (FRT) to measure the muscular fatigue (defined as a reduction in torque production) sustained by the lumbar extensors after a single set of kettlebell swings (KBS) in comparison to isolated lumbar extensions (ILEX), and a control condition (CON). The purpose of which is to measure the physiological response of KBS against an already established modality. Subsequent data provides insight of the efficacy of kettlebells swings in strengthening the lumbar muscles and lower back pain treatment. Eight physically active males participated in a repeated measures design where participants completed all conditions. There were statistically significant reductions in maximal torque, reported as strength index (SI), following both KBS and ILEX exercise. A statistically significant difference was found for reductions in maximal torque (POST-PRE) between CON and both KBS (p = 0.005) and ILEX (p = 0.001) and between KBS and ILEX (p = 0.039). Mean reduction and effect sizes were -1824 ± 1127.12(SI) and -1.62 for KBS and -4775.6 ± 1593.41(SI) and -3.00 for ILEX. In addition a statistically significant difference was found between KBS and ILEX for rate of perceived exertion (p = 0.012). Data suggests that both KBS and ILEX were able to fatigue the lumbar extensors. ILEX was able to generate a greater level of fatigue. However, contrary to previous research, the kettlebell swing was able to elicit a physiological response despite the lack of pelvic restraint supporting the potential to strengthen the lumbar extensors.

PMID: 26439790 [PubMed – as supplied by publisher]

Cost Effectiveness of Lumbar Epidural Steroid Injections.

By London Spine
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Cost Effectiveness of Lumbar Epidural Steroid Injections.

Spine (Phila Pa 1976). 2015 May 20;

Authors: Carreon LY, Bratcher KR, Ammous F, Glassman SD

Abstract
STUDY DESIGN: Longitudinal CohortObjectives. To determine the cost per quality-adjusted life-year (cost/QALY) for lumbar epidural steroid injections (LESI).
SUMMARY OF BACKGROUND DATA: Despite being a widely performed procedure, there are few studies evaluating the cost-effectiveness of LESIs.
METHODS: Patients who had LESI between June 2012 and July 2013 with EQ-5D scores available before and after LESIs but before any surgical intervention were identified. Costs were calculated based on the Medicare Fee Schedule multiplied by the number of LESIs done between the two clinic visits. QALYs were calculated using the EQ-5D.
RESULTS: Of 421 patients who had pre-LESI EQ-5D data, 323 (77%) had post-LESI data available;200 females, 123 males, mean age 59.2 ± 14.2 years. Cost per LESI was $608, with most patients receiving three LESIs over one year (range 1 to 6). Mean QALY gained was 0.005. One hundred forty-five patients (45%) had a QALY gain (mean = 0.117) at a cost of $62,175/QALY gained, 127 (40%) had a loss in QALY (mean = -0.120) and 51 (15%) had no change in QALY. Fourteen of the 145 patients who improved, and 29 of the 178 patients that did not, have medical comorbidities that precluded surgery. Thirty-two (22%) of 131 patients without medical comorbidities who improved; and 57 (32%) of the 149 patients without medical comorbidities who did not improve subsequently had surgery (p = 0.015).
CONCLUSIONS: LESI may not be cost-effective in patients with lumbar degenerative disorders. For the 145 patients who improved, cost per QALY gained was acceptable at $62,175. However for the 178 patients with no gain or a loss in QALY, the economics are not reportable with a cost per QALY gained being theoretically infinite. Further studies are needed in order to identify specific patient populations that will benefit from LESI, as the economic viability of LESI requires improved patient selection.

PMID: 25996536 [PubMed – as supplied by publisher]

Increased pain catastrophizing associated with lower pain relief during spinal cord stimulation: results from a large post-market study

By London Spine

BACKGROUND: Pain catastrophizing is a negative cognitive distortion to actual or anticipated pain. Our aim was to determine if greater catastrophizing has a deleterious relationship with pain intensity and efficacy outcomes in patients receiving SCS. METHODS: As part of an ongoing Institutional Review Board-approved, multi-site, single arm post-market study, 386 patients were implanted with an…

The influence of cricket fast bowlers’ front leg technique on peak ground reaction forces.

By London Spine
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The influence of cricket fast bowlers’ front leg technique on peak ground reaction forces.

J Sports Sci. 2013;31(4):434-41

Authors: Worthington P, King M, Ranson C

Abstract
High ground reaction forces during the front foot contact phase of the bowling action are believed to be a major contributor to the high prevalence of lumbar stress fractures in fast bowlers. This study aimed to investigate the influence of front leg technique on peak ground reaction forces during the delivery stride. Three-dimensional kinematic data and ground reaction forces during the front foot contact phase were captured for 20 elite male fast bowlers. Eight kinematic parameters were determined for each performance, describing run-up speed and front leg technique, in addition to peak force and time to peak force in the vertical and horizontal directions. There were substantial variations between bowlers in both peak forces (vertical 6.7 ± 1.4 body weights; horizontal (braking) 4.5 ± 0.8 body weights) and times to peak force (vertical 0.03 ± 0.01 s; horizontal 0.03 ± 0.01 s). These differences were found to be linked to the orientation of the front leg at the instant of front foot contact. In particular, a larger plant angle and a heel strike technique were associated with lower peak forces and longer times to peak force during the front foot contact phase, which may help reduce the likelihood of lower back injuries.

PMID: 23098100 [PubMed – indexed for MEDLINE]