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Day: January 21, 2017

Assessment and neurologic involvement of patients with cervical spine congenital synostosis as in Klippel-Feil syndrome: study of 19 cases.

By wp_zaman

Assessment and neurologic involvement of patients with cervical spine congenital synostosis as in Klippel-Feil syndrome: study of 19 cases.

J Pediatr Orthop B. 1998 Jul;7(3):179-85

Authors: Rouvreau P, Glorion C, Langlais J, Noury H, Pouliquen JC

We reviewed 19 children and adolescents with cervical spine congenital synostosis as in Klippel-Feil syndrome (KFS), with an average follow-up of 12.5 years. We paid particular attention to neurologic complications associated with cervical spine abnormalities. Five patients were affected by neurologic complications; four underwent a surgical procedure; and 14 had no neurologic finding. Two had hypermobility at one level, and one had hypermobility at two levels. We found that the more numerous the occipito-C1 abnormalities, the more significant the neurologic risk. In contrast, this risk was not related to the number of “mobile blocks” or to age. Various mechanisms of neural complications have been studied in the literature: medullary abnormality, spinal instability, narrowing of the cervical canal, and vascular dysfunction. Surgery is usually thought to be required in cases with neurologic complications. The indication for surgery is, however, less clear in cases of pure instability without neurologic involvement because surgery is likely to increase the future risks at mobile disks either above or below the fuse level. Careful clinical and radiologic observation is necessary in such patients. Magnetic resonance imaging (MRI) with lateral views in flexion and extension seem to be the best method for detecting impingement of the spine on the cord.

PMID: 9702666 [PubMed – indexed for MEDLINE]

The efficacy of a home-mechanical traction unit for patients with mild to moderate cervical osteoarthrosis: A pilot study.

By Kamruz Zaman
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The efficacy of a home-mechanical traction unit for patients with mild to moderate cervical osteoarthrosis: A pilot study.

Med J Islam Repub Iran. 2016;30:386

Authors: Bagheripour B, Kamyab M, Azadinia F, Amiri A, Akbari M

Abstract
BACKGROUND: Traction has been suggested to be an effective treatment for symptoms of neck disorder in patients with no contraindications. However, according to previous researches, the effectiveness of traction is controversial, particularly compared to other conservative treatments. This trial was conducted to evaluate the effect of sustained traction, using an over-the-door home cervical traction unit in combination with routine physical therapy on reducing cervical osteoarthrosis symptoms including neck pain, medication use and disability level compared to routine physical therapy alone.
METHODS: In this double- blinded pilot study with a pre-post test design and a control group, 20 women with mild to moderate osteoarthrosis were systematically assigned to the over-the-door home cervical traction (mean±SD age: 50.5±4.45yrs) or control groups (mean±SD age: 55.6±7.34yrs). Pain, level of disability, and drug consumption were evaluated before and after 10 sessions of intervention. Data were analyzed using parametric or non-parametric statistic including the paired-sample t-test, independent sample t-test, and Wilcoxon and Mann-Whitney u test for intra and inter groups comparison based on the Kolmogorov-Smirnov test results.
RESULTS: Patients in both groups showed a significant decrease in pain intensity and disability level (p<0.05). Despite the greater improvement in pain levels and disability in the experimental group compared to the controls, the differences were not significant (p>0.05). No significant differences were found in terms of drugs consumption within and between the groups at the end of the treatment (p>0.05).
CONCLUSION: The results revealed that applying sustained traction using an over-the-door home cervical traction unit was not significantly superior to the routine physical therapy and ergonomic training to manage symptoms including neck pain and disability in a small group of mild to moderate cervical osteoarthrosis patients.

PMID: 27493930 [PubMed]

Impact of spinal alignment and back muscle strength on shoulder range of motion in middle-aged and elderly people in a prospective cohort study.

By wp_zaman
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Impact of spinal alignment and back muscle strength on shoulder range of motion in middle-aged and elderly people in a prospective cohort study.

Eur Spine J. 2014 Jul;23(7):1414-9

Authors: Imagama S, Hasegawa Y, Wakao N, Hirano K, Muramoto A, Ishiguro N

Abstract
PURPOSE: The relationship between spine and shoulder motion has not been well evaluated. The purpose of this study was to clarify the relationships among thoracic kyphosis and lumbar lordosis, spinal range of motion (ROM), spinal alignment and shoulder ROM.
METHODS: Evaluation of spinal alignment was prospectively conducted in 317 subjects (114 males and 203 females, the average age: 67 years) who attended a public health checkup. Shoulder ROM with an angle meter and shoulder pain were evaluated. Thoracic kyphosis angle, lumbar lordosis angle, thoracic ROM, lumbar ROM and spinal inclination angle were measured using SpinalMouse(®). The relationships of these factors with grip strength, back muscle strength, physical ability, osteoporosis and body mass index were examined and multivariate logistic regression analysis was performed to identify the risk factors for limited shoulder ROM.
RESULTS: Limited shoulder flexion was found in 35 patients (11 %) and limited abduction in 50 patients (16 %). In multivariate logistic regression analyses adjusted for age, shoulder pain and other parameters, increased thoracic kyphosis angle and increased spinal inclination angle were risk factors for limited shoulder flexion (p < 0.05). Increased thoracic kyphosis angle and weak back muscle strength were also determined as risk factors for limited shoulder abduction (p < 0.05).
CONCLUSIONS: This study provides the first evidence that increased thoracic kyphosis, increased spinal inclination and weak back muscle strength are the risk factors for limited shoulder ROM. These results suggest that maintenance of spinal alignment and back muscle strength may be important for better shoulder ROM.

PMID: 24578093 [PubMed – indexed for MEDLINE]

Occult neural foraminal stenosis caused by association between disc degeneration and facet joint osteoarthritis: demonstration with dedicated upright MRI system.

By wp_zaman
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Occult neural foraminal stenosis caused by association between disc degeneration and facet joint osteoarthritis: demonstration with dedicated upright MRI system.

Radiol Med. 2013 Dec 12;

Authors: Splendiani A, Ferrari F, Barile A, Masciocchi C, Gallucci M

Abstract
PURPOSE: The aim of our study was to evaluate the presence of dynamic foraminal stenosis using a new low-field dedicated magnetic resonance (MR) unit with a balancing system that allows images to be acquired both in the recumbent and upright position. Imaging of lumbar spine with the patient in a supine, nonweight-bearing position is likely to misrepresent the degree and potential risk of spinal stenosis.
MATERIALS AND METHODS: In the period between September 2008 and May 2011, we selected 630 symptomatic patients aged 40-65 years (mean age 56) who underwent conventional MR in clinostatic position. The study only included selected patients (total 160) who underwent clinostatic and orthostatic evaluation using a dedicated MR system (G-scan). The biomechanical parameters were also considered. Changes in the dimension of the neural foramina were compared using the presence of disc and facet degeneration by statistical analysis.
RESULTS: Stenosis of the intervertebral foramen was never found in the presence of normal intervertebral discs either in the presence or in the absence of facet disease, in either clinostatic or orthostatic position. Sixty-one stenotic levels were detected which were visualised exclusively in scans obtained under weight-bearing conditions. We named this dynamic condition “occult stenosis”. In all of these cases, disc disease was associated with facet pathology.
CONCLUSION: Our data show that the association between disc pathology and facet osteoarthrosis can cause occult foraminal stenosis. Strategies to image the spine under physiological load conditions may improve the clinical diagnosis of radicular pain.

PMID: 24337755 [PubMed – as supplied by publisher]

Spread of local anesthetic during an ultrasound-guided interscalene block: does the injection site influence diffusion?

By wp_zaman

Spread of local anesthetic during an ultrasound-guided interscalene block: does the injection site influence diffusion?

Acta Anaesthesiol Scand. 2011 Jul;55(6):664-9

Authors: Plante T, Rontes O, Bloc S, Delbos A

During interscalene block (ISB) placement, ultrasound guidance (USG) enables the practitioner to measure the spread of local anesthetic around the nerve trunks or roots, and to adjust the needle position in order to optimize diffusion. Moreover, USG helps determine the best injection level, i.e. the point from which diffusion gives the most complete brachial plexus block. The aim of this study was to compare C5 and C6 level injections and to determine which level allows the best diffusion.

PMID: 21668938 [PubMed – in process]

Severe low back pain as the initial symptom of venous thrombosis of the inferior vena cava.

By wp_zaman
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Severe low back pain as the initial symptom of venous thrombosis of the inferior vena cava.

BMJ Case Rep. 2014;2014

Authors: Tabatabai MA, Butros VM, Mahdi SA, Ahmad MJ

Abstract
A 45-year-old previously well male truck driver presented to the emergency department with severe low back pain; lumbosacral X-ray was normal and he was given analgaesics and discharged. The following day, he presented to the emergency department again, his pain had not responded to the analgaesics; this time he also presented with massive bilateral swelling of lower limbs and left testicle that started 3 h earlier. The pain was severe, dull and interfered with the patient’s ability to walk. An urgent workup revealed extensive thrombosis of the inferior vena cava.

PMID: 25155491 [PubMed – indexed for MEDLINE]

Stereotactic body radiation therapy planning with duodenal sparing using volumetric-modulated arc therapy vs intensity-modulated radiation therapy in locally advanced pancreatic cancer: a dosimetric analysis.

By wp_zaman
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Stereotactic body radiation therapy planning with duodenal sparing using volumetric-modulated arc therapy vs intensity-modulated radiation therapy in locally advanced pancreatic cancer: a dosimetric analysis.

Med Dosim. 2013;38(3):243-50

Authors: Kumar R, Wild AT, Ziegler MA, Hooker TK, Dah SD, Tran PT, Kang J, Smith K, Zeng J, Pawlik TM, Tryggestad E, Ford E, Herman JM

Abstract
Stereotactic body radiation therapy (SBRT) achieves excellent local control for locally advanced pancreatic cancer (LAPC), but may increase late duodenal toxicity. Volumetric-modulated arc therapy (VMAT) delivers intensity-modulated radiation therapy (IMRT) with a rotating gantry rather than multiple fixed beams. This study dosimetrically evaluates the feasibility of implementing duodenal constraints for SBRT using VMAT vs IMRT. Non-duodenal sparing (NS) and duodenal-sparing (DS) VMAT and IMRT plans delivering 25Gy in 1 fraction were generated for 15 patients with LAPC. DS plans were constrained to duodenal Dmax of<30Gy at any point. VMAT used 1 360° coplanar arc with 4° spacing between control points, whereas IMRT used 9 coplanar beams with fixed gantry positions at 40° angles. Dosimetric parameters for target volumes and organs at risk were compared for DS planning vs NS planning and VMAT vs IMRT using paired-sample Wilcoxon signed rank tests. Both DS VMAT and DS IMRT achieved significantly reduced duodenal Dmean, Dmax, D1cc, D4%, and V20Gy compared with NS plans (all p≤0.002). DS constraints compromised target coverage for IMRT as demonstrated by reduced V95% (p = 0.01) and Dmean (p = 0.02), but not for VMAT. DS constraints resulted in increased dose to right kidney, spinal cord, stomach, and liver for VMAT. Direct comparison of DS VMAT and DS IMRT revealed that VMAT was superior in sparing the left kidney (p<0.001) and the spinal cord (p<0.001), whereas IMRT was superior in sparing the stomach (p = 0.05) and the liver (p = 0.003). DS VMAT required 21% fewer monitor units (p<0.001) and delivered treatment 2.4 minutes faster (p<0.001) than DS IMRT. Implementing DS constraints during SBRT planning for LAPC can significantly reduce duodenal point or volumetric dose parameters for both VMAT and IMRT. The primary consequence of implementing DS constraints for VMAT is increased dose to other organs at risk, whereas for IMRT it is compromised target coverage. These findings suggest clinical situations where each technique may be most useful if DS constraints are to be employed.

PMID: 23540490 [PubMed – indexed for MEDLINE]