Validity of the modified back-saver sit-and-reach test: a comparison with other protocols

PURPOSE: Studies have shown that the classical sit-and-reach (CSR) test, the modified sit-and-reach (MSR), and the newly developed back-saver sit-and-reach (BS) test have poor criterion-related validity in estimating low-back flexibility but yielded moderate criterion-related validity in hamstring flexibility. The V sit-and-reach (VSR) test was found to be practical but the validity has not been established. The purpose of this study was to propose a modified back-saver sit-and-reach (MBS) test, which incorporated all advantages of the various protocols, and to compare the criterion-related validity and reliability of all these tests. METHODS: 158 college students (F = 96, and M = 62; age = 20.77 +/- 2.51) performed CSR, VSR, BS (left and right leg), and MBS (left and right leg) tests in a randomized order. Scores from each test were then correlated with the criterion measures. RESULTS: For all sit-reach tests, intraclass reliability (single trial) was very high (r = 0.89-0.98). MBS yielded significant and highest r with low-back and hamstring criterion for men (r = 0.47-0.67) and women (r = 0.23-0.54). The low-back and right hamstring validity of MBS for men were significantly (P < 0.01) higher than those from BS and CSR, whereas no differences in criterion-related validity were found between the MBS and other protocols in women. The ratings of perceived comfort among the sit-and-reach protocols were significantly different (P < 0.001) from each other. The rating for MBS was observed the most comfortable test as compared with other protocols. CONCLUSION: The MBS test is not only a reliable test for hamstring and low-back flexibility, it is also a more practical with improved validity for hamstring and low-back flexibility in men than previous protocols.     

The comparison of regional spinal curvatures and movements in sitting posture in ambulatory children with cerebral palsy having minimal-to-moderate functional limitations

AimTo examine the regional spinal curvatures and movements in the sagittal and frontal planes during sitting position, and the ability to act independently in patients with CP and to compare the differences between children and adolescents with minimal-to-moderate functional limitations.MethodTwenty-one participants diagnosed with CP aged 5–16 years were included. The participants’ Gross Motor Function Classification System (GMFCS) levels were determined and those at levels I (minimal functional limitation group: minFLG) or II-III (moderate functional limitation group: modFLG) were included. Spinal curvatures, mobilities, and inclinations in the sagittal and frontal planes were evaluated in the sitting position using a hand-held, computer-assisted non-invasive electromechanical device. Participants’ functional independence levels were assessed with the Functional Independence Measure (WeeFIM).ResultsIn the sagittal plane, there were no differences in terms of spinal curvatures between the minFLG and modFLG (p > 0.05). Spinal mobility degrees for flexion (thoracic and lumbar regions and total spine), extension (sacral region), and total spine mobility scores were significantly greater in the minFLG (p < 0.05). In the frontal plane, lumbar spinal curvature significantly increased, and total spine mobility in the right/left lateral motions and functional independence decreased in the modFLG (p < 0.05).InterpretationThe children/adolescents with minimal functional limitations had greater spinal mobility during flexion, extension, and lateral flexions. Spinal curvatures were similar between groups in the sagittal plane. The lumbar region posture scores in the frontal plane observed as lordoscoliosis were higher, and functional independence was lower in the modFLG.     

A test of fixed and moving reference point control in posture

This study investigated two contrasting assumptions of the regulation of posture: namely, fixed and moving reference point control. These assumptions were tested in terms of time-dependent structure and data distribution properties when stability is manipulated. Fifteen male participants performed a tightrope simulated balance task that is, maintaining a tandem stance while holding a pole. Pole length (and mass) and the standing support surface (fixed surface/balance board) were manipulated so as to mechanically change the balance stability. The mean and standard deviation (SD) of COP length were reduced with pole length increment but only in the balance board surface condition. Also, the SampEn was lower with greater pole length for the balance board but not the fixed surface. More than one peak was present in the distribution of COP in the majority of trials. Collectively, the findings provide evidence for a moving reference point in the maintenance of postural stability for quiet standing.     

Longitudinal study of vertebral type-1 end-plate changes on MR of the lumbar spine

The purpose of this study was to investigate the temporal evolution of type-1 end-plate changes on MRI in patients with degenerative disease of the lumbar spine and to evaluate whether any correlation exists between such evolution and the change in patients symptoms. Forty-four patients with 48 Modic type-1 end-plate changes (low TI signal and high T2 signal) were studied. All patients had an initial and a follow-up non-contrast lumbar MRI with variable intervals between the studies (12–72 months). Severity of the end-plate changes was assessed by eyeball estimation. Correlation with patients symptoms was studied with the help of the Visual Analogue Score (VAS), Oswestry Questionnaire Score (OQS) and patients subjective assessment. Of the 48 disc levels with type-1 changes, 18 (37.5%) converted fully to type 2 (high T1 signal and intermediate to high T2 signal), 7 (14.6%) partially converted to type 2, 19 (39.6%) became worse (i.e. type 1 changes became more extensive) and 4 (8.3%) showed no change. Higher average VAS (5.7) and OQS (42.3) scores were noted in patients where there was worsening type-1 change and lower scores (3.8 and 27, respectively) were seen in those where there was conversion to type-2 change. These trends, however, did not reach statistical significance (P values 0.16 and 0.09 for VAS and OQS, respectively). The statistical relationship was stronger after exclusion of patients with confounding factors (i.e. changes in lumbar MRI other than end-plate changes that could independently explain the evolution of patients symptoms) with P-values of 0.08 and 0.07 for VAS and OQS, respectively. Type-1 end-plate change represents a dynamic process and in a large majority of cases either converts to type-2 change or becomes more extensive. The evolution of type-1 change relates to change in patients symptoms, but not to a statistically significant level.     

Radiography and photogrammetry-based methods of assessing cervical spine posture in the sagittal plane: A systematic review with meta-analysis

BackgroundThere are numerous radiography and photogrammetry-based methods of assessing the cervical spine posture in the sagittal plane. The choice of instrument should be based on scientific parameters such as validity and reliability, thus avoiding restrictions to the applicability of the instrument.Research questionWhat radiography and photogrammetry-based methods used to assess the cervical spine posture in the sagittal plane are valid and/or reliable?MethodsSystematic searches were conducted following Meta-analysis of Observational Studies in Epidemiology guidelines. Methodological quality was assessed according to the Brink & Louw appraisal tool.ResultsTwenty-one studies were included in the qualitative analysis. Twenty different methods of calculating cervical spine posture in the sagittal plane were found. Two studies included validation measures, 16 studies assessed inter-rater reliability, and 17 studies assessed intra-rater reliability. Fourteen studies were included for the quantitative analysis. The meta-analysis shows that the cervical arrow and cervical lordosis photogrammetry-based methods present very high intra-rater reliability. In radiography, the meta-analysis also showed that the Cobb method (inferior C2 - inferior C7), Cobb method (middle C1 - inferior C7), absolute rotation angle, and Gore angle (C2-C7) present very high inter-rater reliability, and the Cobb method (inferior C2 - inferior C7) and absolute rotation angle present very high intra-rater reliability.SignificanceThis systematic review presents an overview of the methods used to assess cervical spine posture and the respective information on validity and reliability. This panorama facilitates the choice of method when conducting radiography or photogrammetry-based assessment of the cervical spine in the sagittal plane. In addition, it shows the need for new studies that investigate the accuracy and precision of these methods for their possible use in larger studies.     

Osteoid osteoma of the cervical spine

Summary The authors studied the usefulness of MR imaging in the diagnosis of an osteoid osteoma occuring within the C4 left uncinate process. It was detected by scintigraphy and diagnosed by CT. On T2-weighted MR images the nidus showed a very low signal intensity with an increased signal within the adjacent end-plates. This pattern was misleading and more suggestive of degenerative disk disease.     

短节段经伤椎椎弓根螺钉治疗胸腰段骨折

目的 探讨短节段经伤椎椎弓根螺钉治疗胸腰段骨折的适应证、手术方法及临床疗效.方法 对我科从2005年1月至2008年12月收治的38例压缩性骨折和轻中度爆裂性骨折行短节段椎弓根螺钉内固定组(A组)和短节段经伤椎椎弓根螺钉内固定组(B组)各19例.采用伤椎椎体恢复度(R)值(伤椎前缘高度/临近椎体前缘高度的均值×100%)、伤椎后凸Cobb角、神经功能恢复情况(Frankel评分)、患者疼痛的视觉模拟疼痛评分(VSA)及内固定状况进行比较.结果 所有患者均得到6～37个月(平均20.5个月)随访.两种术式术后Frankel评分无明显差异,但B组VAS评分、R值、Cobb角恢复明显优于A组.A组出现螺帽松动、螺钉折弯各1例,无内固定物断裂、松动、脱出.结论 采用短节段经伤椎椎弓根螺钉是治疗压缩性和轻中度爆裂性胸腰段骨折的一种切实有效的方法.     

Evaluation of the cervical spine in the obtunded patient

Assessment of cervical spine stability in the posttraumatic obtunded patient can be difficult to accomplish with currently available imaging modalities. Dynamic fluoroscopy during passive flexion and extension has been proposed by some authors as a method for the evaluation of cervical spine stability. We present our experience with dynamic fluoroscopy, the general opinions of multiple trauma centers, and alternative methods for evaluating cervical spine stability in the obtunded patient. The potential risks and problems associated with each method are discussed.     

Supine oblique views of the cervical spine: A poor proxy for the lateral view

To determine whether supine 45° oblique radiographs of the cervical spine can accurately detect and quantify anteroposterior intervertebral plane displacements, an observer performance study was performed. A normally aligned dry cervicothoracic vertebral specimen and the same specimen with varying degrees of subluxation at one or more levels were radiographed in anteroposterior, lateral, and 45° oblique projections, in a simulated supine position. Twenty-five sets of radiographs were obtained, of which three were normal. In the remaining 22 sets, there were 43 intervertebral segments with an abnormal anteroposterior displacement. Since each intervertebral level (C2-T1) was individually evaluated, the study sample consisted of 150 intervertebral segments. Blinded to experimental conditions, six observers evaluated every intervertebral level on each lateral and oblique image in isolation. The data for each projection were compared using alternative free-response operator characteristic and free-response forced-error methodologies. Significant differences in diagnostic accuracy were detected between the horizontal lateral and the supine oblique views to detect malalignment. Although supine oblique views detected many subluxations, they produced numerous false-negative and false-positive results. The findings of this study suggest that supine oblique views may be a useful part of the standard evaluation of the acutely injured cervical spine; however, they may not reliably portray clinically important anteroposterior displacements.     

胸腰段脊柱爆裂骨折前路与后路手术疗效对比观察

目的 对胸腰椎爆裂骨折行前路手术和后路手术的患者进行回顾性研究,客观评价不同手术入路治疗后的影像学结果,为胸腰椎爆裂骨折的外科治疗提供可靠的参考.方法 筛选2003年1月-2005年12月收治的41例胸腰椎爆裂骨折患者作为研究对象,随访24～48个月,平均38个月.按照手术人路分为前路手术和后路手术两组.根据随访X线侧位片测量Cobb角作为效果评价标准,并进行统计学分析.结果 前路手术组共19例,人院时平均Cobb角为27.3°,术后为3.1°,随访结束时为4.6°;后路手术组共22例,入院时平均Cobb角为26.1°,术后为3.0°,随访结束时为12.5°.两组患者术前和术后即刻Cobb角差异无统计学意义(P>0.05),但随访结束时两者差异有统计学意义(P<0.01).结论 前路手术对于改善和维持胸腰椎爆裂骨折后凸角度优于后路手术.     

仰卧位和俯卧过屈位CT、MRI对腰椎间盘突出症显示的比较研究

目的 研究俯卧过屈位腰椎CT、MR检查对腰椎间盘突出症诊断的临床意义.方法 仰卧位和俯卧过屈位腰椎CT、MRI配对检查腰椎间盘突出症1200例,根据包容型、粘连型及破裂型腰椎间盘突出症的CT、MRI诊断标准,分别对2种体位CT、MR检查的腰椎间盘突出症进行分型,并比较分型的改变.以俯卧过屈位腰椎CT、MR检查为术前选择...     

经皮穿刺切吸椎间盘治疗腰椎间盘突出60例临床体会

目的：探讨经皮穿刺切吸腰椎间盘术中,穿刺点、角度、髓核组织取出量与临床疗效的关系。方法：（１）本组６０例腰椎间盘突出症,共８５个病变椎间盘,均经ＣＴ或ＭＲＩ扫描。（２）穿刺点距体中线的距离为１２～１６ｃｍ,角度≤４５°。结果：穿刺成功率１００％,髓核组织取出量为１．５～５ｇ。治愈３４例（５６．７％）,显效１５例（２５％）,有效９例（１５％）。结论：穿刺点距体中线越远,其穿刺角度越小,与下列因素呈正比关系：（１）工作套管在椎间盘内后１／３径路内活动范围;（２）髓核组织取出量;（３）临床疗效。     

Metastatic disease of the spine

Metastases of the spine occur in the spinal cord, dura extramedullary, epidural space, and vertebral bodies. Imaging modalities can be used to evaluate patient symptoms, screen and detect lesions, assess localization and the compartments involved (extradural, epidural, subdural, and paraspinal), and suggest therapeutic strategies. The suggested flow chart for metastases is (1) in asymptomatic patients suspected for metastases and (2) in the patient with neurological symptoms. Imaging modalities are indispensable in differential diagnosis because some nontumoral lesions can mimic metastases.     

Degenerative disorders of the spine

Patients with back pain and degenerative disorders of the spine have a significant impact on health care costs. Some authors estimate that up to 80% of all adults experience back pain at some point in their lives. Disk herniation represents one of the most frequent causes. Nevertheless, other degenerative diseases have to be considered. In this paper, pathology and imaging of degenerative spine diseases will be discussed, starting from pathophysiology of normal age-related changes of the intervertebral disk and vertebral body.     

A video based method to quantify posture of the head and trunk in sitting

Maintenance of a vertically aligned posture of the head and trunk in sitting is a fundamental skill that demonstrates the presence of neuromotor control. Clinical assessments of posture are generally subjective. Studies have quantified posture using different technologies, but the application of such technologies in a clinical environment remains difficult. Video recordings, however, are easily used clinically and have potential for quantitative analysis of movement. This study used a video-based method to generate a numerical measure of postural alignment of the head and trunk in sitting. Static and dynamic trials of 12 healthy seated adults were simultaneously recorded with a sagittal video camera and a 3D motion capture system. Segmental angles were calculated for the Head, Neck and six Trunk segments. An agreed definition of aligned static sitting posture agreed was used by five clinically experienced experts to identify video frames where the participants’ posture was aligned. The five subsets of frames that defined the aligned posture were combined to give aligned segments (mean ± SD) for each participant. Agreement between experts in the definition (mean) of aligned segmental angles was excellent (ICC = 0.99) and intra-assessor reliability (SD) lay within 2.1°–11.6°. Agreement between the video-based method and the 3D system was below 3.8° and 8.4° for static and dynamic trials respectively. This video-based method allowed the quantification of sitting posture and provided greater detail of the trunk/spinal profile than previous methods. It has potential as a complementary tool, alongside subjective assessments, for patients with a wide variety of pathologies.     

A case of ochronosis: MRI of the lumbar spine

We present the MRI features of the lumbar spine in a patient with ochronosis. Received: 25 October 1999/Accepted: 8 April 2000     

反复体位改变试验中人体心血管参数变化特征

目的 观察人体在头高、头低反复体位改变试验刺激膛心血管参数的变化特征. 方法 在电动立位旋转床上对18名健康男性进行头高、头低反复体位改变试验,实时监测心电图(ECG)、血压(BP)、心率(HR)、每搏量(stroke volume,SV)、心输出量(cardial out,CO)、总外周阻力(total peripheral resistance,TPR)等指标,取试验前平卧位数据为对照,选取每个体位第20秒和第60秒的数据进行分析. 结果 试验中有6名受试者心电图出现了室上性期前收缩、阵发性室上性心动过速、房室传导阻滞等节律改变;18名受试者心血管参数均随着体位改变而变化,其中CO呈现出逐渐下降的趋势,而TPR呈现出逐渐升高的趋势;经过10次头高、头低体位改变后,受试者在-15°/+50°立位应激时SBP、MBP、SV、CO下降幅度有所增加. 结论 头高、头低反复体位改变试验中人体心血管参数呈现出明显的规律性变化;该模式的反复体位改变对人体立位耐力有不利影响.     

Evaluation of traumatic spinal canal stenosis in thoracolumbar burst fractures. A comparison of three methods for measuring the percent canal occlusion

OBJECTIVES: Various percent canal occlusion measurement methods have been used to assess the spinal canal stenosis following a thoracolumbar burst fracture. However, there are no studies performed comparing these techniques. The objective of this study was to determine the reliability of three techniques used to measure the spinal canal stenosis in thoracolumbar burst fractures on lateral radiograph and CT scans, and to identify the most reliable and practical method of assessment. METHODS: Fifty preoperative lateral radiographs and axial computed tomography (CT) scans of thoracolumbar burst fractures were analyzed by five observers in two sessions. The three measurement techniques were tested: the ratio of sagittal diameter of spinal canal at the injury level to that at the adjacent level on lateral plain radiographs (Ratio 1) and on axial CT scans (Ratio 2); and the ratio of cross-sectional area of spinal canal at the injury level to that at the adjacent level on axial CT scans (Ratio 3). Interobserver and intraobserver reliability for each measure was assessed. RESULTS: Greater coefficient of variation (CV) of measurement was founded for the Ratio 1 obtained from lateral plain radiographs than the other two ratios (Ratio 2 and 3) from CT scans (P<0.05), while no differences of CV were noted between the Ratio 2 and Ratio 3 with CT scans (P>0.05). There was no significant improvement (P>0.05) of the interobserver agreement after a 3-month interval for all three methods. A high significant positive correlation was observed between Ratio 1 and Ratio 2, Ratio 1 and Ratio 3, and Ratio 2 and Ratio 3 (P<0.05 for all). CONCLUSIONS: CT scans are more reliable than plain radiographs in the evaluation of spinal canal occlusion in thoracolumbar burst fractures although the agreement might be acceptable for the latter. Measurement of sagittal diameter of spinal canal using CT scan might be a more reasonable choice than of cross-sectional area of spinal canal because of its simplicity and comparable measurement reliability.