Magnetic resonance imaging-based interpretation of degenerative changes in the lower lumbar segments and therapeutic consequences

Intervertebral disc degeneration and facet joint osteoarthritis of the lumbar spine are, among others, well known as a cause of low back and lower extremity pain. Together with their secondary disorders they set a big burden on health care systems and economics worldwide. Despite modern imaging modalities, such as magnetic resonance imaging, for a large proportion of patients with low back pain (LBP) it remains difficult to provide a specific diagnosis. The fact that nearly all the lumbar structures are possible sources of LBP, may serve as a possible explanation. Furthermore, our clinical experience confirms, that imaging alone is not a sufficient approach explaining LBP. Here, the Oswestry Disability Index, as the most commonly used measure to quantify disability for LBP, may serve as an easy-to-apply questionnaire to evaluate the patient’s ability to cope with everyday life. For therapeutic purposes, among the different options, the lumbar facet joint intra-articular injection of corticosteroids in combination with an anaesthetic solution is one of the most frequently performed interventional procedures. Although widely used the clinical benefit of intra-articular steroid injections remains controversial. Therefore, prior to therapy, standardized diagnostic algorithms for an accurate assessment, classification and correlation of degenerative changes of the lumbar spine are needed.     

战士下腰痛的流行病学研究

目的：初步掌握战士下腰痛流行病学,为防治提供参考。方法：随机整群抽取驻西南某部战士1000名,进行个人、工作、心理及下腰痛调查。对下腰痛患者另行VAS和Oswestry功能障碍指数调查。结果：该群体中下腰痛的点患病率为30.4%,年患病率为38.4%;下腰痛患者SCL-90各项因子得分均显著高于对照组;回归分析显示体重、下腰痛史、外伤史、工龄、A工种和躯体化是下腰痛的相关危险因素,焦虑是保护因素;慢性下腰痛患者Oswestry功能障碍指数和VAS评分均最高。结论：战士下腰痛患病率高;亚急性和慢性下腰痛患者心理健康状况较差,功能障碍和疼痛显著,需重点防治。     

下肢血管介入对糖尿病下肢血管病变合并糖尿病足的临床价值及预后

目的:评价下肢血管介入对糖尿病严重下肢血管病变合并糖尿病足的临床价值及糖尿病足的预后情况。方法:40例2型糖尿病伴严重下肢血管病变并有外科截肢手术指征的患者分为2组:观察组、对照组。观察组行下肢血管成形术 药物治疗 局部换药。对照组采用药物治疗 局部换药。分别在术后5天、30天、60天、90天观察并评价两组患者的临床症状、下肢血管内径及足部溃疡愈合情况。结果:观察组临床症状、下肢血管内径、溃疡愈合情况及截肢率明显好于对照组(P<0.01)。结论:糖尿病下肢血管介入手术治疗效果满意,可以降低患者的病残率。     

Resistance band training or general exercise in multidisciplinary rehabilitation of low back pain? A randomized trial

Multidisciplinary biopsychosocial rehabilitation has been recommended for chronic low back pain (LBP ), including physical exercise. However, which exercise modality that is most advantageous in multidisciplinary biopsychosocial rehabilitation is unclear. In this study, we investigated whether multidisciplinary biopsychosocial rehabilitation could be more effective in reducing pain‐related disability when general physical exercise was replaced by strength training in the form of progressive resistance training using elastic resistance bands. In this single‐blinded (researchers), randomized controlled trial, 99 consenting adults with moderate‐to‐severe non‐specific LBP were randomized to three weeks of multidisciplinary biopsychosocial rehabilitation with either general physical exercise or progressive resistance band training and were then instructed to continue with their respective home‐based programs for nine additional weeks, in which three booster sessions were offered. The primary outcome was between‐group difference in change on the Oswestry Disability Index (ODI ) at 12 weeks. Due to early dropouts, data from 74 participants (mean age: 45 years, 57% women, mean ODI : 30.4) were obtained at baseline, 61 participants were followed‐up at 3 weeks, and 46 at 12 weeks. There was no difference in the change in ODI score between groups at 12 weeks (mean difference 1.9, 95% CI : −3.6, 7.4, P  = .49). Likewise, the change in secondary outcomes did not differ between groups, except for the patient‐specific functional scale (0‐10), which favored general physical exercise (mean difference 1.4, 95% CI : 0.1, 2.7, P  = .033). In conclusion, this study does not support that progressive resistance band training compared to general physical exercise improve outcomes in multidisciplinary biopsychosocial rehabilitation for patients with non‐specific LBP .     

Do more MRI findings imply worse disability or more intense low back pain? A cross-sectional study of candidates for lumbar disc prosthesis

Objective

To examine whether combined magnetic resonance imaging (MRI) findings are related to the degree of disability and low back pain (LBP) in candidates for lumbar disc prosthesis surgery.

Materials and methods

This cross-sectional study included 170 disc prosthesis candidates (mean age 41 years; 88 women) with chronic non-radicular LBP and localized disc degeneration. Experienced radiologists rated Modic changes and disc findings at L4-S1 on pre-treatment MRIs. An MRI total score (0–10) for findings at L4/L5 plus L5/S1 was calculated for Modic type I and/or II changes, a posterior high intensity zone (HIZ) in the disc, dark/black nucleus pulposus signal, and ≥40 % disc height decrease. We analyzed the relationship of the MRI total score to the Oswestry Disability Index (ODI) (n?=?170) and LBP intensity scores (0–100 visual analogue scale, n?=?165) using multiple linear regression and adjusting for age, gender, body mass index, smoking, and anxiety/depression.

Results

The MRI total score was not related to ODI (regression coefficient 0.12, p?=?0.79) or LBP intensity (regression coefficient 0.64, p?=?0.37). When individual MRI findings were analyzed, patients with HIZ at L5/S1 had slightly lower ODI scores (4.7 points, p?=?0.02). In post hoc analyses, results remained unchanged after adding facet arthropathy to the MRI total score and adjusting also for physical workload and physical leisure-time activity.

Conclusions

The combined MRI findings were not related to the degree of disability or the intensity of LBP. These degenerative MRI findings cannot explain variation in pre-treatment disability and pain in patients with chronic LBP accepted for disc prosthesis surgery.     

Clinically suspected pulmonary embolism: use of bilateral lower extremity US as the initial examination--a prospective study.

PURPOSE: To determine the prevalence of deep venous thrombosis (DVT) and evaluate the use of symptoms and risk factors as selection criteria in the patient population undergoing lower extremity ultrasonography (US) as an initial examination for suspected pulmonary embolism (PE). MATERIALS AND METHODS: One hundred eighty-two consecutive patients referred for bilateral lower extremity US as the first examination for suspected PE were evaluated prospectively for predisposing factors and symptoms of DVT. Patients were placed into four groups: group 1, no symptoms or risk factors; group 2, both symptoms and risk factors; group 3, only risk factors; group 4, only symptoms. The prevalence of DVT detected at lower extremity US in each group was determined. RESULTS: There were 89 patients in group 1, 12 in group 2, 43 in group 3, and 38 in group 4, with a DVT prevalence of 0%, 25%, 14%, and 24%, respectively. There was no significant difference in DVT prevalence between groups with symptoms or risk factors but a significant difference between these groups and the group lacking both symptoms and risk factors. CONCLUSION: Lower extremity US as the initial examination in patients suspected of having PE should be used only in those patients who have symptoms or risk factors for DVT. This would substantially decrease the number of examinations performed without a decline in DVT detection.     

Low back pain in adolescent female rowers: a multi-dimensional intervention study

The aim of this study was to determine whether a multi-dimensional intervention programme was effective in reducing the incidence of low back pain (LBP) and the associated levels of pain and disability in schoolgirl rowers. This non-randomised controlled trial involved an intervention (INT) group consisting of 90 schoolgirl rowers from one school and a control (CTRL) group consisting of 131 participants from three other schools. All participants in the INT group underwent a multi-dimensional programme that consisted of an individualised exercise programme based on an individual musculoskeletal screening (Week 1) and a LBP education session conducted by a physiotherapist (Week 2) and performed an off-water-conditioning programme conducted by a Physical Education teacher. All exercises were undertaken during the season. Primary outcome variables collected at Start-season, Mid-season, End-season and Post-season included the incidence of LBP and related levels of pain and disability. Secondary outcome variables from the bio-psycho-social domain were measured at Start-season and End-season in the INT group only. The INT group had a lower incidence of LBP at Mid-season and End-season and displayed significantly better results than the CTRL group for improvers and non-improvers with respect to the levels of pain and disability. The INT group following the intervention also displayed improved physical fitness levels, sat with significantly less anterior tilt of the pelvis and lumbar kyphosis when in their usual sitting posture and demonstrated positive changes in their behaviour. The multi-dimensional approach to reducing the incidence of LBP, pain and disability in schoolgirl rowers in this study was effective. Several secondary outcome variables measured in the INT group considered to be of importance in LBP significantly improved. These included physical fitness (aerobic conditioning, lower limb and back muscle endurance and sit and reach flexibility) and seated posture (usual and slump sitting).     

Muscular performance after a 3 month progressive physical exercise program and 9 month follow-up in subjects with low back pain. A controlled study

The purpose of this study was to assess, in subjects with low back pain, the changes and their permanence in muscular performance after a 3 month progressive physical exercise program. Ninety subjects with chronic low back pain participated in the study. The study design was controlled and it was carried out in three groups: intensive training, home exercise, and control group. Isometric and dynamic muscle strength of the trunk and lower limb were measured, at the beginning of the study and after the 3 months exercise program, and then during each of the follow-up sessions. The Oswestry Index and back pain intensity were also determined. Both exercise groups received benefit from the progressive exercise program. Their muscular performance improved and their back pain intensity decreased significantly. Among the home exercise group, the Oswestry Index also changed positively. The results demonstrate that the home exercise program could be as effective as the intensive training program in increasing muscle strength, as well as decreasing back pain and functional disability among low back pain patients with mild functional limitations.     

Endovascular Treatment for Lower Extremity Deep Vein Thrombosis: An Overview

Lower extremity deep vein thrombosis (DVT) is a serious medical condition that can result in local pain and gait disturbance. DVT progression can also lead to death or major disability as a result of pulmonary embolism, postthrombotic syndrome, or limb amputation. However, early thrombus removal can rapidly relieve symptoms and prevent disease progression. Various endovascular procedures have been developed in the recent years to treat DVT, and endovascular treatment has been established as one of the major therapeutic methods to treat lower extremity DVT. However, the treatment of lower extremity DVT varies according to the disease duration, location of affected vessels, and the presence of symptoms. This article reviews and discusses effective endovascular treatment methods for lower extremity DVT.     

Conservative treatment of lateral epicondylitis: brace versus physical therapy or a combination of both-a randomized clinical trial

BACKGROUND: The authors evaluated the effectiveness of brace-only treatment, physical therapy, and the combination of these for patients with tennis elbow. METHODS: Patients were randomized over 3 groups: brace-only treatment, physical therapy, and the combination of these. Main outcome measures were success rate, severity of complaints, pain, disability, and satisfaction. Data were analyzed using both intention-to-treat and per-protocol analyses. Follow-up was 1 year. RESULTS: A total of 180 patients were randomized. Physical therapy was superior to brace only at 6 weeks for pain, disability, and satisfaction. Contrarily, brace-only treatment was superior on ability of daily activities. Combination treatment was superior to brace on severity of complaints, disability, and satisfaction. At 26 weeks and 52 weeks, no significant differences were identified. CONCLUSION: Conflicting results were found. Brace treatment might be useful as initial therapy. Combination therapy has no additional advantage compared to physical therapy but is superior to brace only for the short term.     

Association between lower back pain and lower extremity pain among young volleyball players: A cross-sectional study

BackgroundLower back pain (LBP), as well as lower extremity injuries, are major problems among young volleyball players. Nevertheless, only few studies have focused on the relationship between lower extremity injuries and LBP.ObjectiveThis study investigated the association between LBP and lower extremity pain, including knee and ankle pain, among young volleyball players.DesignCross-sectional study.SettingAmateur sports association.ParticipantsElementary and middle school-aged athletes (6–15 years of age).Main outcome measuresLBP and lower extremity pain.ResultsA total of 566 young volleyball players participated in this study. The point prevalence of LBP among young volleyball players was 9.5%. Using absence of lower extremity pain as a reference, the adjusted odds ratio (95% confidence interval) for LBP was 11.07 (5.64–21.71) in the presence of lower extremity pain.ConclusionsLBP is associated with Lower extremity pain among young volleyball players. Careful attention should be paid to lower extremity complaints to prevent and treat LBP among young volleyball players.     

Back pain and MRI changes in the thoraco‐lumbar spine of young elite Mogul skiers

Athletes have a higher prevalence of LBP and spinal abnormalities on Magnetic Resonance Imaging (MRI) compared to non‐athletes. The objective of this study was to investigate the amount of spinal MRI abnormalities and the lifetime prevalence of low back pain (LBP) in 16 young elite Mogul skiers compared to 28 non‐athletes in the corresponding age in a cross‐sectional design. LBP was assessed by a questionnaire consisting of a part regarding previous or present back pain, the Oswestry disability index, and the EuroQol questionnaire. MRI examinations from Th5 to sacrum were conducted to evaluate spinal pathologies. The Mogul skiers had significantly more MRI abnormalities (like disc degeneration) in mean (7.25 vs 3.78, P < 0.023) compared to the controls. No significant difference was seen regarding the lifetime LBP prevalence between the groups (50% vs 42%, P = 0.555). No correlation could be found between disc degeneration and back pain in this study. Young elite Mogul skiers, compared to an age‐matched control group of non‐athletes, have an increased risk of developing spinal abnormalities potentially due to the different high loads that they are subjected to in their sport. Future relationship between the MRI abnormalities and LBP cannot be verified by this study design.     

介入溶栓治疗下肢深静脉血栓的效果评价及预后影响因素分析

目的分析介入溶栓治疗下肢深静脉血栓（DVT）的临床效果及影响预后的相关因素。 方法回顾性分析2012年7月—2015年6月收治的65例DVT形成患者的临床资料,男27例,女38例,平均年龄59.9岁,其中予单纯药物治疗16例、药物+置管溶栓治疗23例、药物+置管溶栓+机械溶栓联合治疗26例;44例患者行滤器置入术。 结果65例患者经治疗后,截止随访治疗有效52例,无效及复发13例,平均住院时间16.2 d,围手术期死亡0例。Logistic回归分析显示疾病病程和治疗方法是影响DVT预后的影响因素,多元回线性归分析显示住院时间与病程、血栓解剖位置、滤器有线性回归关系（P<0.05）。 结论疾病病程和治疗方法是影响DVT患者预后的影响因素,病程、血栓解剖位置、治疗方法及滤器是影响住院时间的因素,早期合适的诊治,可降低DVT的再发及并发症。     

Low back pain in athletes and non-athletes: a group comparison of basic pain parameters and impact on sports activity

Introduction

Low back pain (LBP) is a major health issue in athletes and non-athletes often accompanied by considerable restrictions in everyday functioning. Knowledge about differences between those groups regarding LBP parameters (intensity, duration, and disability) and their influence on daily life is still lacking. Hence, the present study aimed at the comparison of those LBP parameters between athletes and non-athletes and the impact of these factors on sports activity.

Methods

LBP patients receiving prescribed sport- or physiotherapeutic treatment (N = 264) completed a questionnaire battery to determine their LBP pain intensity, duration, chronification, disability, and changes in sports activity. The categorization into athletes and non-athletes was based on performance level. Uni- and multivariate analyses of (Co-) variance and nonparametric group comparisons were executed to analyze group differences.

Results

Disability was lower in the athlete’s group, especially concerning work ability (p < 0.05). Athletes rather continued with their sports activity despite LBP (p < 0.001). The interaction between age and difference in training volume showed that non-athletes (<29 years) reported a greater reduction of training volume from a pain free to a LBP phase compared to athletes in the respective age group.

Conclusions

The results imply that athletes with LBP perceive less impairment than non-athletes concerning disability and changes in training volume. Possible explanations can be inferred from different socialization processes and pain coping mechanisms among athletes. The outcomes contribute to the existing literature by adding specific knowledge about dissimilarities between athletes and non-athletes regarding the appraisal of LBP.

     

运动疗法对部队下腰痛病例的干预效果评价

目的 评价徒手核心肌力训练和悬吊运动疗法对下腰痛病例的干预效果.方法 以空军某场站部分下腰痛官兵为研究对象,采用抽签方式将144例下腰痛患者随机分成3组,第1组为徒手核心肌力组(徒手核心肌力训练+普通物理治疗),第2组为悬吊运动疗法组(悬吊运动疗法+普通物理治疗),第3组为对照组(普通物理治疗组),每组48例,开展6周干预试验.干预前、干预2周、4周、6周后分别对3组病例发放调查问卷,了解腰痛程度(VAS评分)、腰椎功能状况(Roland评分)及活动度(FFD评分),同步测量并观察3组病例的腰部肌力变化. 结果 全程参与的3组人数分别是:徒手核心肌力组43例,悬吊运动疗法组43例,对照组44例;徒手核心肌力组VAS评分为3.25、Roland评分为5.83、FFD评分为8.58;悬吊运动疗法组VAS评分为3.30、Roland评分为5.93、FFD评分为8.10;对照组VAS评分为2.41、Roland评分为3.03、FFD评分为7.40.3组下腰痛干预有效率分别为90.90%、85.13%和46.82%.试验组组间各项指标均无显著性差异(P>0.05),与对照组比较有显著性差异(P<0.05). 结论 徒手核心肌力训练和悬吊运动疗法对下腰痛病例均有明显疗效.在不同环境下,部队卫生机构可根据相应的设施条件对下腰痛病例选用徒手核心肌力训练或悬吊运动疗法进行干预,从而有效缓解下腰痛.     

Endovascular treatment of venous malformations in extremities: results of sclerotherapy and the quality of life after treatment

Purpose: To evaluate the long-term results of endovascular sclerotherapy in treating venous extremity malformations and to assess the quality of life after treatment.

Material and Methods: Twenty-four patients were included who had completed treatment with ethanol sclerotherapy and a minimum of one year observation period. Nineteen patients attended a clinical control. To evaluate the quality of life after treatment, 23 patients filled in a questionnaire which included 20 multiple-choice questions exploring four dimensions: psychological, physical and social functioning, and pain.

Results: At the clinical control seven patients had no clinical symptoms related to the malformation, six had slight, four moderate, and two severe symptoms. In 16 patients the symptoms had diminished after treatment. No deterioration of the initial situation was observed. The results concerning quality of life showed that most patients did well after endovascular treatment. Pain was the most important injurious factor for state of health among the four different dimensions. The poorest outcome was found in malformations that filled the whole muscle or muscle compartment and in larger lesions. The patients whose malformation at the clinical control caused swelling to the extremity affected had poorer quality indices than others.

Conclusion: Endovascular treatment for venous malformations is an effective treatment.     

Factors associated with discharge during marine corps basic training

This prospective study assessed risk factors for discharge from basic training (BT) among 2,137 male Marine Corps recruits between February and April 2003. Physical and demographic characteristics, exercise, and previous lower extremity injuries before arrival at Marine Corps Recruit Depot were assessed by questionnaire during intake processing. Stress fractures were confirmed by x-ray, triple-phase bone scan, or magnetic resonance imaging. Overall, 223 (10.4%) participants were discharged from training. In addition to the occurrence of a stress fracture during BT, older age (>23 years), non-Hispanic race, poor incoming self-rated physical fitness, no history of competitive exercise, and an incoming lower extremity injury with incomplete recovery were independent risk factors for discharge. Strategies to identify and allow the proper healing time for pre-BT lower extremity injuries, including interventions to improve the physical fitness of recruits before BT and reduce stress fractures during BT, may be indicated to lower attrition.     

Fat content of lumbar paraspinal muscles in patients with chronic low back pain and in asymptomatic volunteers: quantification with MR spectroscopy

PURPOSE: To prospectively evaluate the fat content of paraspinal muscles by using proton magnetic resonance (MR) spectroscopy in patients with chronic low back pain (LBP) and in asymptomatic volunteers matched with regard to age, sex, and body mass index. MATERIALS AND METHODS: The study was approved by the responsible institutional review board. Informed consent was obtained from each patient and each volunteer. Single-voxel proton MR spectroscopy was used to measure the fat content of the lumbar multifidus and longissimus muscles in 25 patients (13 women, 12 men; mean age, 40.5 years) with chronic LBP and in 25 matched asymptomatic volunteers (13 women, 12 men; mean age, 39.8 years). The fat content was also graded semiquantitatively (grades 0-4). The relationship between fat content and LBP duration, LBP intensity, and self-rated disability was assessed (Pearson correlation). RESULTS: The mean percentage fat content of the multifidus muscle was 23.6% (95% confidence interval [CI]: 17.5%, 29.7%) in patients with chronic LBP and 14.5% (95% CI: 10.8%, 18.3%) in the volunteers (P = .014). The corresponding values for the longissimus muscle were 29.3% (95% CI: 23.4%, 35.3%) in patients with LBP and 26.0% (95% CI: 21.9%, 30.0%) in the volunteers (P = .66). The semiquantitative grading of the fat content of the multifidus muscle was 0 in 12 (48%) of 25 patients and in 14 (56%) of 25 volunteers, 1 in 11 (44%) patients and in eight (32%) volunteers, and 2 in two (8%) patients and three (12%) volunteers. The semiquantitative grading of the fat content of the longissimus muscle was 0 in nine (36%) of 25 patients and 15 (60%) of 25 volunteers, 1 in 13 (52%) patients and nine (36%) volunteers, and 2 in three (12%) patients and one (4%) volunteer. Neither grade 3 nor grade 4 was assigned to any muscle. The grading differences were not significant between patients and volunteers. No significant correlation was found between fat content and pain intensity, pain duration, or self-rated disability. CONCLUSION: Proton MR spectroscopy demonstrates a significantly higher fat content in the multifidus muscle in patients with chronic LBP than in asymptomatic volunteers. No difference was detected with a semiquantitative grading system.     

Predictors of clinical outcome in patients receiving local intra-arterial thrombolysis without subsequent symptomatic intracranial hemorrhage against acute middle cerebral artery occlusion

BACKGROUND AND PURPOSE: The factors that predict favorable outcome after local intra-arterial thrombolysis (LIT) remain unknown. We aimed to clarify these factors in patients with middle cerebral artery occlusion treated by LIT. METHODS: We performed LIT in 26 consecutive patients who had middle cerebral artery occlusion with a modified Rankin scale (mRS) score or=3). RESULTS: The duration from symptom onset to hospital admission was 0.96 +/- 0.87 (mean +/- SD) hour and from onset of stroke to LIT was 3.78 +/- 1.17 hours. No patients developed symptomatic intracerebral hemorrhage or died. Thirteen patients achieved good outcomes. No significant differences existed between the two groups in baseline National Institutes of Health Stroke Scale (NIHSS) scores, time from stroke onset to LIT, blood pressure, early CT signs, or subsequent hemorrhagic transformation shown by CT. However, univariate analysis showed that patients with good outcomes were younger, more often had absence of hypertension history, had better collaterals shown by angiography, and had better recanalization rates than those with poor outcomes. NIHSS scores after LIT were lower in patients with good outcomes than in patients with poor outcomes. Logistic regression analysis indicated improvement of the NIHSS scores by >or=2 immediately after LIT was independently associated with good outcome. CONCLUSION: Improvement of the NIHSS score by >or=2 immediately after LIT is a useful predictor of patient outcome at discharge.     

下肢深静脉血栓局部溶栓的疗效与影响因素

目的 探讨下肢深静脉血栓局部溶栓治疗的疗效及影响因素。方法 对60例下肢深静脉血栓形成患者,采用经导管血栓局部先团注量灌注尿激酶250000U,然后以125000－150000U／h持续灌注。结果 全组溶栓治疗时间4－76h,平均38h,尿激酶用量750000U－9750000U,平均5150000U,血管再通率88．3％。病程＜4周的急性或亚急性血栓形成患者46例,溶栓后阻塞段血管再通44例（95．7％）。在14例慢性血栓形成患者中,血管再通9例（64．3％）。对残存狭窄＞30％的23例患者,14例行经皮球囊血管成形术（PTA）治疗,9例行PTA及内支架治疗。溶栓术后继续肝素全身抗凝治疗可增强溶栓疗效。6例溶栓前放置下腔静脉过滤器。本组无严重并发症及肺栓塞发生。结论 经导管血栓局部灌注尿激酶是治疗下肢深静脉血栓的安全有效方法,其疗效与多种因素有关。