Background
:
Recent work has demonstrated that low back pain is a common complaint following low-speed collisions. Despite frequent pain reporting, no studies involving human volunteers have been ...completed to examine the exposures in the lumbar spine during low-speed rear impact collisions.
Methods
:
Twenty-four participants were recruited and a custom-built crash sled simulated rear impact collisions, with a change in velocity of 8 km/h. Randomized collisions were completed with and without lumbar support. Inverse dynamics analyses were conducted, and outputs were used to generate estimates of peak L4/L5 joint compression and shear.
Results
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Average (SD) peak L4/L5 compression and shear reaction forces were not significantly different without lumbar support (compression = 498.22 N 178.0 N; shear = 302.2 N 98.5 N) compared to with lumbar support (compression = 484.5 N 151.1 N; shear = 291.3 N 176.8 N). Lumbar flexion angle at the time of peak shear was 36° (12°) without and 33° (11°) with lumbar support.
Conclusion
:
Overall, the estimated reaction forces were 14% and 30% of existing National Institute of Occupational Safety and Health occupational exposure limits for compression and shear during repeated lifting, respectively. Findings also demonstrate that, during a laboratory collision simulation, lumbar support does not significantly influence the total estimated L4/L5 joint reaction force.
Major lumbar spine surgery causes severe postoperative pain. The primary objective of this randomized controlled study was to compare the effect of ultrasound (US)-guided erector spinae plane (ESP) ...block on 24-hour postoperative cumulative opioid requirements with standard (opioid-based) analgesia. Postoperative pain control and patient satisfaction were also assessed.
Adults scheduled for elective lumbar spine surgery under general anesthesia were randomly assigned to the following (and they are): Control group-no preoperative ESP block, or ESP block group-preoperative bilateral US-guided ESP block. Both groups received standard general anesthesia during surgery. Postoperative pain score, number of patients requiring rescue analgesia, and total morphine consumption during the first 24 postoperative hours were recorded. Patient satisfaction was assessed 24 hours after surgery.
Postoperative morphine consumption was significantly lower in patients in the ESP group compared with those in the control group (1.4±1.5 vs. 7.2±2.0 mg, respectively; P<0.001). All patients in the control group required supplemental morphine compared with only 9 (45%) in the ESP block group (P=0.002). Pain scores immediately after surgery (P=0.002) and at 6 hours after surgery (P=0.040) were lower in the ESP block group compared with the control group. Patient satisfaction scores were more favorable in the block group (P<0.0001).
US-guided ESP block reduces postoperative opioid requirement and improves patient satisfaction compared with standard analgesia in lumbar spine surgery patients.
ABSTRACT
A number of studies investigated the distribution of BMD values and the prevalence of osteoporosis in China, but their findings varied. Until now, a BMD reference database based on uniform ...measurements in a large‐scale Chinese population has been lacking. A total of 75,321 Chinese adults aged 20 years and older were recruited from seven centers between 2008 and 2018. BMD values at the lumbar spine (L1–L4), femoral neck, and total femur were measured by GE Lunar dual‐energy X‐ray absorptiometry systems. BMD values measured in each center were cross‐calibrated by regression equations that were generated by scanning the same European spine phantom 10 times at every center. Cubic and multivariate linear regression were performed to assess associations between BMD values and demographic variables. Sex‐specific prevalence of osteoporosis was age‐standardized based on the year 2010 national census data for the Chinese population. The sex‐specific BMD values at each site were negatively associated with age, positively associated with body mass index levels, and lower in the participants from southwest China than in those from other geographic regions after multivariate adjustment. Furthermore, BMD values at the femoral neck and total femur decreased with the year of BMD measurement. The peak BMD values at the lumbar spine, femoral neck, and total femur were 1.088 g/cm2, 0.966 g/cm2, and 0.973 g/cm2, respectively, for men, and 1.114 g/cm2, 0.843 g/cm2, and 0.884 g/cm2, respectively, for women. The age‐standardized prevalence of osteoporosis at the spine or hip was 6.46% and 29.13% for men and women aged 50 years and older, respectively. Currently a total of 10.9 million men and 49.3 million women in China are estimated to have osteoporosis. In our national examination of BMD, we found that BMD values differed by demographic characteristics. We estimated the age‐standardize prevalence of osteoporosis in China to be 6.46% and 29.13% respectively, for men and women aged 50 years and older.
A retrospective study was performed to assess the diagnostic contribution of oblique view films of the lumbar spine, to information obtained from anteroposterior (AP) and lateral films, as an initial ...screening tool for the detection of pars interarticularis defects. Twenty-two cases of lumbar spondylolysis were selected from 243 lumbar spine reports, randomly combined with 40 plain X-rays of normal lumbar spines, and evaluated by radiology residents. The frequency of correctly detecting a pars defect on lateral vs. right and left oblique views was determined. Of the bilateral spondylolyses, 85% were diagnosed on lateral films compared to 35% on oblique radiographs. Both views gave poor diagnostic yield in detecting unilateral pars defects. In evaluating a total of 186 X-rays, an average of 31 oblique films were incorrectly diagnosed, as compared to an average of 14 misdiagnosed lateral films. Considering the low sensitivity associated with the use of oblique view radiography, in addition to the extra cost and significantly increased radiation exposure seen with this procedure, our findings indicate that oblique views should be used only for selected patients who might require further investigation. We therefore recommend that the initial lumbosacral radiological evaluation be limited to AP and lateral views.
•Synthetic CT is generated from MRI using a deep learning-based image synthesis method.•Synthetic CT is equivalent to CT in quantitatively assessing lumbar bony morphology.•Synthetic CT is promising ...for use in preoperative diagnosis and surgery planning.
MRI is the imaging modality of choice for soft tissue-related spine disease. However, CT is superior to MRI in providing clear visualization of bony morphology. The purpose of this study is to test equivalency of MRI-based synthetic CT to conventional CT in quantitatively assessing bony morphology of the lumbar spine.
A prospective study with an equivalency design was performed. Adult patients who had undergone MRI and CT of the lumbar spine were included. Synthetic CT images were generated from MRI using a deep learning-based image synthesis method. Two readers independently measured pedicle width, spinal canal width, neuroforamen length, anterior and posterior vertebral body height, superior and inferior vertebral body length, superior and inferior vertebral body width, maximal disc height, lumbar curvature and spinous process length on synthetic CT and CT. The agreement among CT and synthetic CT was evaluated using equivalency statistical testing.
Thirty participants were included (14 men and 16 women, range 20–60 years). The measurements performed on synthetic CT of pedicle width, spinal canal width, vertebral body height, vertebral body width, vertebral body length and spinous process length were statistically equivalent to CT measurements at the considered margins. Excellent inter- and intra-reader reliability was found for both synthetic CT and CT.
Equivalency of MRI-based synthetic CT to CT was demonstrated on geometrical measurements in the lumbar spine. In combination with the soft tissue information of the conventional MRI, this provides new possibilities in diagnosis and surgical planning without ionizing radiation.
Prospective, follow-up study.
We aim to compare the rate of revisions for ASD after LSF surgery between patients with IS and DLSD.
ASD is a major reason for late reoperations after LSF surgery. ...Several risk factors are linked to the progression of ASD, but the understanding of the underlying mechanisms is imperfect. If IS infrequently becomes complicated with ASD, it would emphasize the role of the ongoing degenerative process in spine in the development of ASD.
365 consecutive patients that underwent elective LSF surgery were followed up for an average of 9.7 years. Surgical indications were classified into 1) IS (n = 64), 2) DLSD (spinal stenosis with or without spondylolisthesis) (n = 222), and 3) other reasons (deformities, postoperative conditions after decompression surgery, posttraumatic conditions) (n = 79). All spinal reoperations were collected from hospital records. Rates of revisions for ASD were determined using Kaplan-Meier methods.
Altogether, 65 (17.8%) patients were reoperated for ASD. The incidences of revisions for ASD in subgroups were 1) 4.8% (95% CI: 1.6%-22.1%); 2) 20.5% (95% CI: 15.6%-26.7%); 3) 20.6% (95% CI: 12.9%-31.9%). After adjusting the groups by age, sex, fusion length, and the level of the caudal end of fusion, when comparing with IS group, the other groups had significantly higher hazard ratios (HR) for the revision for ASD 2) HR (95% CI) 3.92 (1.10-13.96), P = 0.035, 3) HR (95% CI) of 4.27 (1.11-15.54), P = 0.036.
Among patients with IS, the incidence of revisions for ASD was less than a 4th of that with DLSD. Efforts to prevent the acceleration of the degenerative process at the adjacent level of fusion are most important with DLSD.Level of Evidence: 3.
Low back pain is a very common symptom and the leading cause of disability throughout the world. Several degenerative imaging findings seen on magnetic resonance imaging are associated with low back ...pain but none of them is specific for the presence of low back pain as abnormal findings are prevalent among asymptomatic subjects as well. The purpose of this population‐based study was to investigate if more specific magnetic resonance imaging predictors of low back pain could be found via texture analysis and machine learning. We used this methodology to classify T2‐weighted magnetic resonance images from the Northern Finland Birth Cohort 1966 data to symptomatic and asymptomatic groups. Lumbar spine magnetic resonance imaging was performed using a fast spin‐echo sequence at 1.5 T. Texture analysis pipeline consisting of textural feature extraction, principal component analysis, and logistic regression classifier was applied to the data to classify them into symptomatic (clinically relevant pain with frequency ≥30 days and intensity ≥6/10) and asymptomatic (frequency ≤7 days, intensity ≤3/10, and no previous pain episodes in the follow‐up period) groups. Best classification results were observed applying texture analysis to the two lowest intervertebral discs (L4‐L5 and L5‐S1), with accuracy of 83%, specificity of 83%, sensitivity of 82%, negative predictive value of 94%, precision of 56%, and receiver operating characteristic area‐under‐curve of 0.91. To conclude, textural features from T2‐weighted magnetic resonance images can be applied in low back pain classification.
Abstract Background: Preemptive analgesia is a method of administration of drugs prior to surgery involving blocking noxious stimuli across the perioperative period. It involves blocking the pain ...pathway preemptively before injury-induced hypersensitivity manifests. Objective: To compare the analgesic efficacy of duloxetine with pregabalin as preemptive analgesic in lumbar spine surgeries. Design: Randomised, double-blinded, prospective study. Methods: Fifty patients of both sexes between 18-55yrs undergoing elective lumbar spine surgery were randomly allocated into two groups, group P and group D of twenty-five patients each. Group P received 75 mg pregabalin once daily for three days, followed by 150 mg pregabalin daily for the next four days till the day of surgery. Group D received 20 mg duloxetine once daily for three days, followed by 40 mg duloxetine twice daily for the next four days till the day of surgery. Outcome Measure: Both the groups were primarily evaluated in terms of time for request of 1 st rescue analgesic and total intraoperative analgesic requirement in terms of fentanyl boluses required; among other parameters. Results: The time for request of 1 st rescue analgesic postoperatively was significantly longer in the pregabalin group (396 ± 267.77 min) than in the duloxetine group (218.4 ± 96.9 min), P = 0.003. Pregabalin recipients required considerably less rescue analgesics in terms of dosage, P = 0.006. Also, pregabalin exhibited better postoperative pain control than duloxetine as reflected by NRS comparative scores. No statistical difference was appreciated in terms of intraoperative fentanyl requirement, intraoperative hemodynamic control; nausea and sleepiness. Conclusion: Pregabalin is more efficacious as a preemptive analgesic than duloxetine in lumbar spine surgery.
STUDY DESIGN.Retrospective, comparative.
OBJECTIVE.i) To design an enhanced recovery after surgery (ERAS) protocol for elective lumbar spine fusion by posterior approach, ii) To compare the results ...after ERAS implementation in patients undergoing elective lumbar spine fusion with conventional perioperative care
SUMMARY OF BACKGROUND DATA.Despite wide adoption in other surgical disciplines, ERAS has only been recently implemented in spine surgery. The integrated multidisciplinary approach of ERAS aims to reduce surgical stress to achieve better outcomes.
METHODS.Hospital records of adult patients who underwent 1- to 3-level elective lumbar spine fusion by posterior approach at a single centre were retrospectively studied. An ERAS protocol was designed based on the prevalent hospital practices, local resources and supportive evidence from literature. The ERAS protocol was implemented at our institute in December 2016 – dividing patients into pre-ERAS and post-ERAS groups. The outcome measures for comparison werelength of hospital stay (LOS), postoperative complications, 60-day readmission rate, 60-day reoperation rate and patient reported outcome measures (VAS and ODI score) at stipulated time intervals.
RESULTS.A total of 812 patients were included – 496 in the pre-ERAS group and 316 in the post-ERAS group. There was no significant difference between the two groups in baseline demographic, clinical and surgery-related variables. Patients in the post-ERAS group had a significantly shorter LOS (2.94 days v/s 3.68 days). The rate of postoperative complications (13.5% v/s 11.7%), 60-day readmission (1.8% v/s 2.2%) and 60-day reoperation (1.2% v/s 1.3%) did not differ significantly between the pre-ERAS and post-ERAS groups. The VAS and ODI scores, similar at baseline – were significantly lower in the post-ERAS group (VAS49.8 ± 12.0 v/s 44 ± 10.8, ODI31.6 ± 14.2 v/s 28 ± 12.8) at 4 weeks after surgery. This difference however was not significant at intermediate term follow up (6 months and 12 months).
CONCLUSION.Implementation of an ERAS protocol is feasible for elective lumbar spine fusion, and leads to shorter LOS and improved early pain and functional outcome scores.Level of Evidence3
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