Overview: the role of Propionibacterium acnes in nonpyogenic intervertebral discs.

By London Spine
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Overview: the role of Propionibacterium acnes in nonpyogenic intervertebral discs.

Int Orthop. 2016 Jan 28;

Authors: Chen Z, Cao P, Zhou Z, Yuan Y, Jiao Y, Zheng Y

Abstract
Propionibacterium acnes (P. acnes), an important opportunistic anaerobic Gram-positive bacterium, causes bone and joint infections, discitis and spondylodiscitis. Accumulated evidence suggested that this microbe can colonise inside intervertebral discs without causing symptoms of discitis. Epidemiological investigation shows that the prevalence ranges from 13 % to 44 %. Furthermore, colonisation by P. acnes inside nonpyogenic intervertebral discs is thought to be one pathogen causing sciatica, Modic changes and nonspecific low back pain. Specially, patients can attain significant relief of low back pain, amelioration of Modic changes and alleviation of sciatica after antibiotic therapy, indicating the role of P. acnes in these pathological changes. However, until now, there were hypotheses only to explain problems such as how P. acnes access intervertebral discs and what the exact pathological mechanism it employs during its latent infection period. In addition, research regarding diagnostic procedures and treatment strategies were also rare. Overall, the prevalence and possible pathological role that P. acnes plays inside nonpyogenic intervertebral discs is summarised in this paper.

PMID: 26820744 [PubMed – as supplied by publisher]

Psychosocial, physical, and neurophysiological risk factors for chronic neck pain: A prospective inception cohort study.

By London Spine
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Psychosocial, physical, and neurophysiological risk factors for chronic neck pain: A prospective inception cohort study.

J Pain. 2015 Sep 20;

Authors: Shahidi B, Curran-Everett D, Maluf KS

Abstract
The purpose of this investigation was to identify modifiable risk factors for the development of first-onset chronic neck pain among an inception cohort of healthy individuals working in a high risk occupation. Candidate risk factors identified from previous studies were categorized into psychosocial, physical, and neurophysiological domains, which were assessed concurrently in a baseline evaluation of 171 office workers within the first 3 months of hire. Participants completed monthly online surveys over the subsequent year to identify the presence of chronic interfering neck pain, defined as a Neck Disability Index score ≥5 points for 3 or more months. Data were analyzed using backwards logistic regression to identify significant predictors within each domain, which were then entered into a multivariate regression model adjusted for age, sex, and body mass index. Development of chronic interfering neck pain was predicted by depressed mood (OR=3.36(1.10-10.31), p=0.03), cervical extensor endurance (OR=0.92(0.87-0.97), p=0.001), and diffuse noxious inhibitory control (OR=0.90(0.83-0.98), p=0.02) at baseline. These findings provide the first evidence that individuals with pre-existing impairments in mood and descending pain modulation may be at greater risk for developing chronic neck pain when exposed to peripheral nociceptive stimuli such as that produced during muscle fatigue.
PERSPECTIVE: Depressed mood, poor muscle endurance, and impaired endogenous pain inhibition are predisposing factors for the development of new onset chronic neck pain of non-specific origin in office workers. These findings may assist with primary prevention by allowing clinicians to screen for individuals at risk of developing chronic neck pain.

PMID: 26400680 [PubMed – as supplied by publisher]

Which is more effective in adolescent idiopathic scoliosis surgery: batroxobin, tran-x-amic acid or a combination?

By London Spine

Which is more effective in adolescent idiopathic scoliosis surgery: batroxobin, tran-x-amic acid or a combination?

Arch Orthop Trauma Surg. 2011 Sep 10;

Authors: Xu C, Wu A, Yue Y

Abstract
BACKGROUND: Adolescent idiopathic scoliosis surgery is often associated with significant blood loss and blood transfusion. In this clinical trial, the authors investigated the efficacy of reducing blood loss and allogeneic blood transfusion by using batroxobin, tran-x-amic acid (TXA) and the combination of the two agents. METHODS: 80 adolescent patients undergoing scheduled idiopathic scoliosis surgery were randomly divided into four groups to receive 0.9% saline (group A), batroxobin (group B), TXA (group C), and both two agents in the same manner (group D). The amounts of blood loss, transfusion requirements, frozen fresh plasma (FFP) and overall drainage were assessed. The hemoglobin concentration (Hb), hematocrit and platelet counts were recorded preoperative y, postoperatively and on the first operative day. The coagulation parameters were measured meanwhile. Deep vein thrombosis (DVT) was diagnosed by ultrasound. RESULTS: Blood loss of group B and group C decreased similarly by 35.3 and 42.8% (p = 0.212) compared with group A, while group D was reduced by 64.5, 45.1 and 37.8% compared to group A, B and C, respectively. The amount of allogeneic blood transfusion of group B and group C was comparably reduced by 57.6 and 72.4% compared to group A (p = 0.069), while group D decreased by 94.7, 87.5 and 80.9% compared to group A, B and C. Overall drainage of group B, C and D decreased by 23.0, 45.1 and 67.9% compared with group A, respectively, while group C was reduced by 28.7% compared with group B (p < 0.001). The FFP of group B, C and D was reduced by 63.4, 80.2 and 95.0% as compared with group A, while group C decreased by 45.9% as compared to group B (p = 0.025). There were no urgent coagulation disorders or DVT reported. CONCLUSIONS: In our study, batroxobin and TXA can markedly reduce the blood loss and the transfusion requirements equivalently. However, TXA performs better in minimizing FFP and the overall drainage than batroxobin. The combination seems to achieve best results and was more effective than either of the two drugs alone. No apparent adverse events were detected in these groups.

PMID: 21909815 [PubMed – as supplied by publisher]

A description of neck motor performance, neck pain, fatigue, and mental effort while driving in a sample with chronic whiplash-associated disorders.

By London Spine
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A description of neck motor performance, neck pain, fatigue, and mental effort while driving in a sample with chronic whiplash-associated disorders.

Am J Phys Med Rehabil. 2014 Aug;93(8):665-74

Authors: Takasaki H, Treleaven J, Johnston V, Van den Hoorn W, Rakotonirainy A, Jull G

Abstract
OBJECTIVE: Individuals with chronic whiplash-associated disorders (WADs) often note driving as a difficult task. This study’s aims were to (1) compare, while driving, neck motor performance, mental effort, and fatigue in individuals with chronic WAD against healthy controls and (2) investigate the relationships of these variables and neck pain to self-reported driving difficulty in the WAD group.
DESIGN: This study involved 14 participants in each group (WAD and control). Measures included self-reported driving difficulty and measures of neck pain intensity, overall fatigue, mental effort, and neck motor performance (head rotation and upper trapezius activity) while driving a simulator.
RESULTS: The WAD group had greater absolute path of head rotation in a simulated city area and used greater mental effort (P = 0.04), but there were no differences in other measures while driving compared with the controls (all P ≥ 0.05). Self-reported driving difficulty correlated moderately with neck pain intensity, fatigue level, and maximum velocity of head rotation while driving in the WAD group (all P < 0.05).
CONCLUSIONS: Individuals with chronic WAD do not seem to have impaired neck motor performance while driving yet use greater mental effort. Neck pain, fatigue, and maximum head rotation velocity could be potential contributors to self-reported driving difficulty in this group.

PMID: 24743457 [PubMed – indexed for MEDLINE]

Intra and Inter-Rater Reliability and Convergent Validity of FIT-HaNSA in Individuals with Grade ? Whiplash Associated Disorder.

By Kamruz Zaman
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Intra and Inter-Rater Reliability and Convergent Validity of FIT-HaNSA in Individuals with Grade П Whiplash Associated Disorder.

Open Orthop J. 2016;10:179-89

Authors: Pierrynowski M, McPhee C, P Mehta S, C MacDermid J, Gross A

Abstract
BACKGROUND: Whiplash-Associated Disorders (WAD) are common following a motor vehicle accident. The Functional Impairment Test – Hand, and Neck/Shoulder/Arm (FIT-HaNSA) assesses upper extremity physical performance. It has been validated in patients with shoulder pathology but not in those with WAD.
OBJECTIVES: Establish the Intra and inter-rater reliability and the known-group and construct validity of the FIT-HaNSA in patients with Grade II WAD (WAD2).
METHODS: Twenty-five patients with WAD2 and 41 healthy controls were recruited. Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI), Disabilities of the Arm, Shoulder and Hand (DASH), cervical range of motion (CROM), and FIT-HaNSA were completed at two sessions conducted 2 to 7 days apart by two raters. Intraclass correlation coefficients (ICC) were used to describe Intra and inter-rater reliability. Spearman rank correlation coefficients (ρ) were used to quantify the associations between scores of the FIT-HaNSA and other measures in the WAD2 group (convergent construct validity).
RESULTS: The Intra and inter-ICCs for the FIT-HaNSA scores ranged from 0.88 to 0.89 in the control group and 0.78 to 0.85 in the WAD2 group. Statistically significant differences in FIT-HaNSA performance between the two groups suggested known group construct validity (P < 0.001). The correlations between the NPRS, NDI, DASH, CROM and FIT-HaNSA were generally poor (ρ < 0.4).
CONCLUSION: The study results indicate that the total FIT-HaNSA score has good Intra and inter-rater reliability and the construct validity in WAD2 and healthy controls.

PMID: 27350797 [PubMed]

Clinical and Radiological Study Focused on Relief of low Back Pain Following Decompression Surgery in Selected Patients of Lumbar Spinal Stenosis Associated with Grade I Degenerative Spondylolisthesis.

By Kamruz Zaman

Clinical and Radiological Study Focused on Relief of low Back Pain Following Decompression Surgery in Selected Patients of Lumbar Spinal Stenosis Associated with Grade I Degenerative Spondylolisthesis.

Spine (Phila Pa 1976). 2016 Aug 3;

Authors: Ikuta K, Masuda K, Tominaga F, Sakuragi T, Kai K, Kitamura T, Senba H, Shidahara S

Abstract
STUDY DESIGN: A retrospective study.
OBJECTIVE: The aim of this study was to identify the clinical and radiological features of low back pain (LBP) that was relieved following decompression alone of lumbar spinal stenosis (LSS) associated with Grade I lumbar degenerative spondylolisthesis (LDS).
SUMMARY OF BACKGROUND DATA: Although decompression and fusion is generally the recommended surgical treatment of LDS, several authors have reported that some patients with LDS could obtain good clinical results including relief from LBP by decompression alone. However, the pathogenesis of relief from LBP following decompression is not known.
METHODS: Forty patients with LSS associated with Grade I LDS, who underwent a minimally invasive surgical (MIS)-decompression were enrolled in this study. All patients complained preoperatively of predominantly leg-related symptoms and LBP (4 points ≤ on Numeric rating scale: NRS). Clinical and radiological assessments were performed 1-year post-surgery (a relief of LBP: NRS reduction ≥ 3 points and valuation ≤ 3 points) and at the last follow-up (FU). We conducted a comparative study between patient groups with and without the relief from LBP (Group R and N, respectively).
RESULTS: Twenty-nine patients were distributed to Group R and remaining 11 patients to Group N. Preoperatively, there was a significant difference between the two groups for age, and radiographic flexibility for lumbar extension. Postoperatively, there was a positive correlation between improvement in both LBP and leg symptoms. The clinical outcomes of Group R were significantly better than those of Group N throughout FU period (mean 37 months). In Group R, sagittal lumbo-pelvic radiographic parameters improved significantly post-surgery.
CONCLUSION: Although the causes of LBP are varied in each patients, our results show that concomitant LSS itself might cause LBP in some patients of Grade I LDS, since it involves impingement of the neural tissue and discordant sagittal lumbo-pelvic alignment.
LEVEL OF EVIDENCE: 3.

PMID: 27488289 [PubMed – as supplied by publisher]