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•Patients with gout have impaired muscle quality.•Patients with gout may be at increased risk of sarcopenia.•The importance of sarcopenia in rheumatic diseases is increasingly ...recognized.
Patients with gout are at elevated risk of multiple vascular and metabolic comorbidities. Whether they are also at risk of sarcopenia, which is known to affect patients with other rheumatic diseases, has not been previously assessed. We examined whether patients with gout have decreased lumbar muscle quality and quantity, indicating an association between gout and sarcopenia.
Fifty gout subjects and 25 controls, ages 45–80, underwent computed tomography imaging of the lumbosacral spine. We measured muscle quantity (skeletal muscle area SMA and index SMI) and quality (skeletal muscle radiation attenuation SMRA and intermuscular adipose tissue IMAT area and index IMATI) of the psoas and erector spinae muscles at the L3 level.
Seventy subjects (45 gout and 25 controls) were included in the analysis. Gout subjects had higher BMI, more kidney disease and hypertension, lower exercise frequency, and higher mean serum urate and creatinine vs. controls. Lumbar SMRA was significantly lower in gout subjects vs. controls, indicating reduced muscle quality. Lumbar IMAT area was significantly higher in gout subjects vs. controls, as was lumbar IMATI, indicating increased muscle adiposity. These differences persisted after adjusting for potential confounders. In contrast, there was no significant difference between gout and control groups in lumbar SMA or lumbar SMI, suggesting that muscle quantity may not be routinely affected by the diagnosis of gout.
Gout patients exhibit decreased lumbar muscle quality compared with controls, consistent with an association between gout and sarcopenia.
Aim of the study: The aim of the study was to assess the influence of stabilization exercises on the intensity of pain and the results of the FMS test in patients with lumbar spine discopathy. ...Material and methods: The study included 30 patients (16 women and 14 men) aged from 25 to 68 years (x ̅=40.6±9.6) with diagnosed discopathy in the lumbar spine. Patients were qualified to be examined by a physician based on the results of imaging tests and information provided in the interview. A control group (reference group) was also created, which qualified 30 healthy people (16 women and 14 men) with average training, which were the most similar in terms of analyzed parameters to the people from the study group. The preliminary examination included functional evaluation with the FMS test and the subjective scale of VAS pain. In addition, each of the study participants filled out their own questionnaire. Then, a 14-day cycle of stabilization exercises was applied to all participants of the study. After completed rehabilitation, the patients underwent functional assessment again with the FMS test and the subjective VAS pain scale. Results: The results of the study have shown that deep muscle training has a significant effect on the reduction of pain in the lumbar spine. Targeted exercises have a positive effect on the improvement of global movement patterns. Studies show that patients' age had a significant impact on final results in FMS tests. The analysis of the conducted research shows that there are no significant differences between the test group and the control group both in the context of perceived pain and results in the final FMS tests. Studies have confirmed that undertaking regular physical activity has a positive effect on the functional status of patients. Conclusion: Stabilization training in patients with diagnosed discopathy in the lumbar spine has a positive effect on reducing back pain and functional status.
Aim of the study: The aim of the study was to assess the influence of stabilization exercises on the intensity of pain and the results of the FMS test in patients with lumbar spine discopathy. ...Material and methods: The study included 30 patients (16 women and 14 men) aged from 25 to 68 years (x ̅=40.6±9.6) with diagnosed discopathy in the lumbar spine. Patients were qualified to be examined by a physician based on the results of imaging tests and information provided in the interview. A control group (reference group) was also created, which qualified 30 healthy people (16 women and 14 men) with average training, which were the most similar in terms of analyzed parameters to the people from the study group. The preliminary examination included functional evaluation with the FMS test and the subjective scale of VAS pain. In addition, each of the study participants filled out their own questionnaire. Then, a 14-day cycle of stabilization exercises was applied to all participants of the study. After completed rehabilitation, the patients underwent functional assessment again with the FMS test and the subjective VAS pain scale. Results: The results of the study have shown that deep muscle training has a significant effect on the reduction of pain in the lumbar spine. Targeted exercises have a positive effect on the improvement of global movement patterns. Studies show that patients' age had a significant impact on final results in FMS tests. The analysis of the conducted research shows that there are no significant differences between the test group and the control group both in the context of perceived pain and results in the final FMS tests. Studies have confirmed that undertaking regular physical activity has a positive effect on the functional status of patients. Conclusion: Stabilization training in patients with diagnosed discopathy in the lumbar spine has a positive effect on reducing back pain and functional status.
Retrospective review of prospectively collected data.
To determine the Oswestry Disability Index (ODI) cutoff for achieving Patient Acceptable Symptom State (PASS) at one year following minimally ...invasive lumbar spine surgery.
An absolute score denoting PASS, rather than a change score denoting minimal clinically important difference (MCID), might be a better metric to assess clinical outcomes.
Patients who underwent primary minimally invasive transforaminal lumbar interbody fusion or decompression were included. The outcome measure was ODI. The anchor question was the Global Rating Change: "Compared with preoperative, you feel (1) much better, (2) slightly better, (3) same, (4) slightly worse, or (5) much worse." For analysis, it was collapsed to a dichotomous outcome variable (acceptable=response of 1 or 2, unacceptable=response of 3, 4, or 5). Proportion of patients achieving PASS and the ODI cutoff using receiver operating characteristic curve analyses were assessed for the overall cohort as well as subgroups based on age, sex, type of surgery, and preoperative ODI. Differences between the PASS and MCID metrics were analyzed.
A total of 137 patients were included. In all, 87% of patients achieved PASS. Patients less than or equal to 65 years and those undergoing fusion were more likely to achieve PASS. The receiver operating characteristic curve analysis revealed an ODI cutoff of 25.2 to achieve PASS (area under the curve: 0.872, sensitivity: 82%, specificity: 83%). The subgroup analyses based on age, sex, and preoperative ODI revealed area under the curve >0.8 and ODI threshold values consistent between 25.2 and 25.5 (except 28.4 in patients with preoperative ODI >40). PASS was found to have significantly higher sensitivity compared with MCID (82% vs. 69%, P =0.01).
Patients with ODI <25 are expected to achieve PASS, irrespective of age, sex, and preoperative disability. PASS was found to have significantly higher sensitivity than MCID.
3.
Chordoma is a rare, malignant neoplasm thought to develop from the notochord. It most commonly occurs in the base of the cranium or the sacro-coccygeal region but around 15%-20% affect the vertebral ...body. Extra-lesional resection with or without adjuvant radiotherapy is generally accepted as the mainstay of treatment for this slow-growing tumor. We present a case whereby a patient with an extensive vertebral body lesion causing caudal compression, treated with spinal decompression and posterior stabilization. This case highlights the importance of pre-operative tissue diagnosis, and that, although rare (0.8 per 100,000), chordoma should always be considered.
Although quantitative measurements improve the assessment of disc degeneration, acquirement of quantitative measurements relies on manual segmentation on lumbar magnetic resonance images (MRIs), ...which may introduce subjective bias. To date, only a few semiautomatic systems have been developed to quantify important components on MRIs.
To develop a deep learning based program (Spine Explorer) for automated segmentation and quantification of the vertebrae and intervertebral discs on lumbar spine MRIs.
Cross-sectional study.
The study was extended on the Hangzhou Lumbar Spine Study, a population-based study of mainland Chinese with focuses on lumbar degenerative changes. From this population-based database, 50 sets lumbar MRIs were randomly selected as training dataset, and another 50 as test dataset.
Regions of vertebrae and discs were manually segmented on T2W sagittal MRIs to train a convolutional neural network for automated segmentation. Intersection-over-union was calculated to evaluate segmentation performance. Computational definitions were proposed to acquire quantitative morphometric and signal measurements for lumbar vertebrae and discs. MRIs in the test dataset were automatically measured with Spine Explorer and manually with ImageJ.
Intraclass correlation coefficient (ICC) were calculated to examine inter-software agreements. Correlations between disc measurements and Pfirrmann score as well as age were examined to assess measurement validity.
The trained Spine Explorer automatically segments and measures a lumbar MRI in half a second, with mean Intersection-over-union of 94.7% and 92.6% for the vertebra and disc, respectively. For both vertebra and disc measurements acquired with Spine Explorer and ImageJ, the agreements were excellent (ICC=0.81~1.00). Disc measurements significantly correlated to Pfirrmann score, and greater age was associated with greater anterior disc bulging area (r=0.35~0.44) and fewer signal measurements (r=−0.62~−0.77) as automatically acquired with Spine Explorer.
Spine Explorer is an efficient, accurate, and reliable tool to acquire comprehensive quantitative measurements for lumbar vertebra and disc. Implication of such deep learning based program can facilitate clinical studies of the lumbar spine.
Research focused on the association of opioid use disorder (OUD) on postoperative outcomes in patients undergoing primary lumbar laminectomy is lacking. This study aims to observe the impact of OUD ...on (1) hospital length of stay (LOS), (2) readmission rates, (3) medical complications, and (4) health care expenditures.
A retrospective query was performed using a nationwide claims database from January 2005 to March 2014 for all patients who underwent lumbar laminectomy, yielding a total of 131,635 patients. The study cohort included 3515 patients with OUD, while 128,120 patients served as the comparison cohort. Multivariate binomial logistic regression analyses were used to determine the association of OUD on readmission rates and medical complications, whereas Welch's
tests were used to compare LOS and health care expenditures. A
value less than 0.001 was considered statistically significant.
Patients with OUD undergoing lumbar laminectomy had significantly longer hospital LOS (3.68 vs 1.13 days,
< 0.0001). Readmission rates were significantly higher (14.57% vs 7.39%, OR: 1.73,
< 0.0001) in patients who had an OUD. The study cohort was found to have higher incidence and odds (32.36% vs 9.76%, OR: 3.53,
< 0.0001) of 90-day medical complications and total global 90-day episode of care reimbursement rates ($13,635.81 vs $8131.20,
< 0.0001) compared with their counterparts.
This study demonstrates OUD to be associated with longer hospital LOS, increased rates of 90-day readmissions, medical complications, and health care expenditures following lumbar laminectomy.
Results indicate that OUD is associated with worse outcomes following lumbar laminectomy.
OBJECTIVE:To assess the risk of spondylolysis by sport in nonelite adolescent athletes with low back pain (LBP).
DESIGN:Retrospective case series.
SETTING:Hospital-based sports medicine clinic.
...PATIENTS:The medical charts of 1025 adolescent athletes with LBP (age 15 ± 1.8 years) were examined; 308 (30%) were diagnosed with a spondylolysis.
ASSESSMENT OF RISK:Risk of spondylolysis was assessed in 11 sports for males and 14 sports for females.
MAIN OUTCOME MEASURE:Relative risk of diagnosis of spondylolysis injury.
RESULTS:The risk of spondylolysis differed by sex with baseball (54%), soccer (48%), and hockey (44%) having the highest prevalence in males and gymnastics (34%), marching band (31%), and softball (30%) for female athletes. Baseball was the only sport to demonstrate a significant increased risk of spondylolysis.
CONCLUSIONS:The sports with the greatest risk of spondylolysis in adolescent athletes in this study were not consistent with published literature. Clinicians should be cautious generalizing high-risk sports to their practice, as geographic region and level of the athlete may significantly influence the incidence of spondylolysis in the population they are treating.
Lumbar laminectomy is a surgical procedure allowing for decompression of neural structures. A wide laminectomy to adequately decompress neural elements without compromising the structural integrity ...of the spinal column is ideal. Pars interarticularis fractures with spinal instability after isolated laminectomy from overresection of the posterior elements have been reported. There are limited anatomical studies in the spine literature that measure the pars interarticularis distance (PID) and spinal canal width (SCW) in the lumbar spine.
The purpose of this study was to assess the differences in PID and SCW at each level of the lumbar spine and to determine their effects on the extent of laminectomy at each lumbar level.
We performed an anatomic study measuring PID and SCW in the lumbar spine from 93 skeletally matured osseous specimens. Groups were compared using an independent sample
test, 1-way analysis of variance, and Wilcoxon test, and significance was set at
< 0.05.
Our study suggests that the distance between PID and SCW increases from L1 to L5 in African American and Caucasian women and men. However, the respective increase in SCW at each lumbar level is less than the respective increase in PID at the same levels. This trend suggests that there is a wider window available for decompression without compromising spinal stability in the lower lumbar spine compared with the upper lumbar spine.
Our findings suggest that the upper lumbar spine has a narrower window for decompression; therefore, care should be taken to preserve as much of the pars at L1-L3. Understanding the variations in PID and SCW in the lumbar spine will help surgeons perform adequate decompression of a stenotic canal while avoiding postoperative spinal instability.
Awareness of PID to SCW ratio may help spine surgeons avoid iatrogenic instability, postoperative intractable back pain, spondylolisthesis, or complications involving alterations of the lumbar spine biomechanics.
Sclerotic lumbar chordoma: A case report Ansari, Owaiz; Anand, Rohit; Serdynski, Kevin Christopher ...
Radiology case reports,
09/2022, Letnik:
17, Številka:
9
Journal Article
Recenzirano
Odprti dostop
Chordoma is a rare tumor, often occurring in the cervical spine and sacrococcygeal spine with a lytic appearance, but rarely in the thoracolumbar spine. Chordomas can occasionally be sclerotic and ...are included in the differential diagnosis for an ivory vertebra. We present a case of a sclerotic chordoma in an upper lumbar vertebral body with corresponding multimodality imaging. This case demonstrates that chordoma should be a concern for an older adult with a sclerotic vertebral lesion, particularly if it is a solitary lesion. Knowledge of the variable location and appearance of chordomas is critical so it is not mistaken for a metastasis.
