Dysfunctional muscle activities and co-contraction in the lower-limb of lumbar disc herniation patients during walking

AbstractThis study aimed to investigate lower-limb muscle activities in gait phases and co-contraction of one gait cycle in patients with lumbar disc herniation (LDH). This study enrolled 17 LDH patients and 17 sex- and age-matched healthy individuals. Bilateral muscle activities of the rectus femoris (RF), biceps femoris long head (BL), tibialis anterior (TA), and lateral gastrocnemius (LG) during walking were recorded. The gait cycle was divided into four phases by the heel strike and top off according to the kinematics tracks. Root mean square (RMS), mean frequency (MF), and co-contraction of surface electromyography signals were calculated. The LDH patients showed enhanced BL RMS during the single support phase (SS), second double support phase, and swing phase (SW) as well as decreased MF of RF during SS and of TA and LG during SW (p < 0.05). The co-contraction of the TA-LG was increased in LDH patients than in the control group (p < 0.05). Positive correlations were observed between TA-LG co-contraction (affected side, r = 0.557, p = 0.020; contralateral side, r = 0.627, p = 0.007) and the Oswestry disability index scores in LDH patients. LDH patients have increased BL firing rate and insufficient motor unit recruitment in specific phases in the lower limbs during walking. Dysfunction in LDH patients was associated with immoderate intermuscular co-contraction of the TA-LG during walking.

Download Full-text

Sciatic Herpes Zoster Suspected of Lumbar Disc Herniation: An Infrequent Case Report and Literature Review

Frontiers in Surgery ◽

10.3389/fsurg.2021.663740 ◽

2021 ◽

Vol 8 ◽

Author(s):

Fei-Long Wei ◽

Tian Li ◽

Yang Song ◽

Lin-Ya Bai ◽

Yifang Yuan ◽

...

Keyword(s):

Back Pain ◽

Case Report ◽

Herpes Zoster ◽

Literature Review ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lower Limb ◽

Lumbar Disc ◽

Lower Limbs ◽

The Right

Background: The symptoms of sciatic herpes zoster are sometimes difficult to distinguish from sciatica caused by lumbar disc herniation. We describe a case of suspected lumbar disc herniation with sciatic herpes zoster to reduce the rate of misdiagnosis.Case Report: A 55-year old man, male, developed low back pain after carrying heavy items 20 years ago. Characteristics of symptoms: 1. Symptoms were aggravated in the upright lumbar forward flexion position; 2. The VAS (leg) score was 8–9 points and the VSA (lumbar) score was 0 point; 3. It can be relieved when rested in the supine position; 4. It came on intermittently with radiation pain in the right lower limb. There were several attacks every year. One month ago, there was radiating pain in the right lower limb. The pain was from the back of the right hip, behind the thigh, in lateral crural region, to the back of the foot. And Symptoms worsened for 10 days. The VAS score was 8 points. Pain could not be relieved by rest or changing posture. There was no back pain, no lower limbs, weak walking, no claudication and other symptoms. Analgesics and neurotrophic drugs are ineffective. After the application of antiviral drugs, the radiation pain in the right lower extremity was significantly relieved.Conclusion: We describe this case in detail and discuss how to make an authentic diagnosis, with a concomitant literature review.

Download Full-text

The relationship of the shear wave elastography findings of patients with unilateral lumbar disc herniation and clinical characteristics

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2814-7 ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Qingyuan Wang ◽

Hao Zhang ◽

Jinxin Zhang ◽

Hanqi Zhang ◽

Hui Zheng

Keyword(s):

Sciatic Nerve ◽

Shear Wave ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Clinical Characteristics ◽

Lumbar Disc ◽

Shear Wave Elastography ◽

Control Group ◽

Symptom Duration ◽

Foraminal Stenosis

Abstract Background The aim of this study was to find out whether the shear wave elastography (SWE) findings of patients with unilateral lumbar disc herniation (LDH) were related to clinical characteristics. Methods For this purpose, the study group included patients (N = 20; 13 male, 7 female) with complaints of unilateral sciatica, with foraminal stenosis caused by one level of LDH (L4-L5 or L5-S1). An gender-and age-matched control group (N = 27; 16 male, 11 female) was included. All the patients were examined on both the axial and longitudinal planes bilaterally at the same level using a convex array probe (1- 6 MHz, Supersonic Imagine, Aix en Provence, France). Results The sciatic nerve stiffness measured on longitudinal planes of the affected side was significantly higher than unaffected side (p < 0.001) and the control group (P < 0.05). Furthermore, the symptom duration of unilateral LDH is positively correlated with the stiffness the sciatic nerve (r = 0.52, p = 0.019). Conclusion According to these findings, ultrasound imaging can be considered as a useful tool to detect changes in the sciatic nerve due to disc herniation. This technique will have a promising prospect for many patients with unilateral LDH in monitoring stiffness during rehabilitation and before or after surgery.

Download Full-text

Integrative TCM Conservative Therapy for Low Back Pain due to Lumbar Disc Herniation: A Randomized Controlled Clinical Trial

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2013/309831 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Wei An Yuan ◽

Shi Rong Huang ◽

Kai Guo ◽

Wu Quan Sun ◽

Xiao Bing Xi ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Conservative Therapy ◽

Lumbar Disc ◽

Control Group ◽

Low Back ◽

Randomized Controlled ◽

Experimental Group

Low back pain due to lumbar disc herniation (LDH) is very common in clinic. This randomized controlled trial was designed to investigate the effects of integrative TCM conservative therapy for low back pain due to LDH. A total of 408 patients with low back pain due to LDH were randomly assigned to an experimental group with integrative TCM therapy and a control group with normal conservative treatment by the ratio of 3 : 1. The primary outcome was the pain by the visual analogue scale (VAS). The secondary outcome was the low back functional activities by Chinese Short Form Oswestry Disability Index (C-SFODI). Immediately after treatment, patients in the experimental group experienced significant improvements in VAS and C-SFODI compared with the control group (between-group difference in mean change from baseline, −16.62 points,P<0.001in VAS; −15.55 points,P<0.001in C-SFODI). The difference remained at one-month followup, but it is only significant in C-SFODI at six-month followup (−7.68 points,P<0.001). No serious adverse events were observed. These findings suggest that integrative TCM therapy may be a beneficial complementary and alternative therapy for patients with low back pain due to LDH.

Download Full-text

The relationship of the shear wave elastography findings of patients with unilateral lumbar disc herniation and clinical characteristics

10.21203/rs.2.11168/v3 ◽

2019 ◽

Author(s):

qingyuan wang ◽

jinxin zhang ◽

hanqi zhang ◽

hui zheng ◽

Hao Zhang

Keyword(s):

Sciatic Nerve ◽

Shear Wave ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Clinical Characteristics ◽

Lumbar Disc ◽

Shear Wave Elastography ◽

Control Group ◽

Symptom Duration ◽

Foraminal Stenosis

Abstract Abstract Background The aim of this study was to find out whether the shear wave elastography (SWE) findings of patients with unilateral lumbar disc herniation (LDH)were related to clinical characteristics . Methods For this purpose,the study group included patients(N=20; 13 male, 7 female) with complaints of unilateral sciatica , with foraminal stenosis caused by one level of LDH (L4-L5 or L5-S1).An gender-and age-matched control group(N=27; 16 male, 11 female) was included.All the patients were examined on both the axial and longitudinal planes bilaterally at the same level using a convex array probe(1- 6MHz,Supersonic Imagine,Aix en Provence,France). Results The sciatic nerve stiffness measured on longitudinal planes of the affected side was significantly higher than unaffected side (p < 0.001)and the control group (P<0.05).Furthermore,the symptom duration of unilateral LDH is positively correlated with the stiffness the sciatic nerve(r=0.52,p=0.019). Conclusion According to these findings, ultrasound imaging can be considered as a useful tool to detect changes in the sciatic nerve due to disc herniation. This technique will have a promising prospect for many patients with unilateral LDH in monitoring stiffness during rehabilitation and before or after surgery. Keywords Ultrasound 、Sciatic nerve、Shear wave elastography、lumbar disc herniation

Download Full-text

The relationship of the shear wave elastography findings of patients with unilateral lumbar disc herniation and clinical characteristics

10.21203/rs.2.11168/v2 ◽

2019 ◽

Author(s):

qingyuan wang ◽

jinxin zhang ◽

hanqi zhang ◽

hui zheng ◽

Hao Zhang

Keyword(s):

Sciatic Nerve ◽

Shear Wave ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Clinical Characteristics ◽

Lumbar Disc ◽

Shear Wave Elastography ◽

Control Group ◽

Symptom Duration ◽

Foraminal Stenosis

Download Full-text

Unilateral partial hemilaminectomy for disc removal in a 1-year-old child

Journal of Neurosurgery Pediatrics ◽

10.3171/ped/2008/2/8/133 ◽

2008 ◽

Vol 2 (2) ◽

pp. 133-135 ◽

Cited By ~ 16

Author(s):

Mony Benifla ◽

Igor Melamed ◽

Revital Barrelly ◽

Andrey Aloushin ◽

Ilan Shelef

Keyword(s):

Differential Diagnosis ◽

Low Back Pain ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Unusual Case ◽

Lumbar Disc ◽

Traumatic Injury ◽

Lower Limbs ◽

Low Back ◽

Structural Elements

Intravertebral disc herniation is common in adults, often due to degenerative processes. The occurrence of disc herniation is rare in children and is usually related to traumatic injury. The authors present an unusual case of a 13-month-old boy with L5–S1 lumbar disc herniation. The disc was removed via a unilateral partial hemilaminectomy approach, sparing the spinal midline structural elements. Although rare, lumbar disc herniation should be in the differential diagnosis for children presenting with low-back pain and/or neurological deficit of the lower limbs.

Download Full-text

Value of ultrasound-guided transforaminal nerve block in the treatment of lumbar disc herniation

Journal of International Medical Research ◽

10.1177/0300060520910910 ◽

2020 ◽

Vol 48 (4) ◽

pp. 030006052091091

Author(s):

Liu Guang-hui ◽

Zhu Guang-yu ◽

Liu Yu-zhang ◽

Zhu Yong-Tao ◽

Zhang Shi-min ◽

...

Keyword(s):

Nerve Block ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Japanese Orthopaedic Association ◽

Lumbar Vertebra ◽

Control Group ◽

Study Group ◽

Ultrasound Guided ◽

Lumbar Intervertebral Disc

Objective This study was performed to investigate the effectiveness and safety of ultrasound-guided transforaminal nerve block in the treatment of lumbar disc herniation. Methods Sixty patients who underwent treatment for protrusion of a lumbar intervertebral disc in Wangjing Hospital from January 2016 to December 2017 were divided into the study group and the control group. The visual analog scale (VAS) pain scores, the Japanese Orthopaedic Association (JOA) scores of the lumbar vertebra, PRI (pain rating index), and PPI (present pain intensity) were recorded at 30 minutes, 1 week, and 3 months after the operation. Results There were significant differences in the VAS, JOA, PRI, and PPI scores between the study group and control group. Conclusion Ultrasound guidance can improve the efficacy and safety of transforaminal nerve block in the treatment of lumbar disc herniation and shorten the operative duration.

Download Full-text

Posterior ring apophysis separation combined with lumbar disc herniation in adults: a 10-year experience in the surgical management of 87 cases

Journal of Neurosurgery Spine ◽

10.3171/2010.11.spine10392 ◽

2011 ◽

Vol 14 (4) ◽

pp. 475-483 ◽

Cited By ~ 30

Author(s):

Ali Akhaddar ◽

Hatim Belfquih ◽

Mohamed Oukabli ◽

Mohammed Boucetta

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Adult Patients ◽

Preoperative Imaging ◽

Control Group ◽

Duration Of Symptoms ◽

Computed Tomography Scanning ◽

Male Patients ◽

Posterior Ring

Object The association of posterior ring apophysis separation (PRAS) with lumbar disc herniation (LDH) is uncommon and represents a true subgroup of disc herniation mainly seen in the adolescent population. The objective of this study was to describe a decade of experience in the care of adult patients with PRAS with LDH, giving particular attention to its diagnosis, surgical treatment, and outcome. Methods This retrospective study focuses on a case series of adult patients with PRAS associated with LDH who underwent surgery for lumbar disc disease in the author's neurosurgical department between 1999 and 2008. Posterior ring apophysis separation was diagnosed in 87 (5.35%) of 1625 patients surgically treated for LDH; these patients made up the PRAS group. During a 6-month period in 2005, LDH without PRAS was diagnosed in 89 consecutive patients at the same facility; these patients constituted the control group. Presenting symptoms, physical examination findings, and preoperative imaging results were obtained from medical records. Immediate operative results were assessed, as were complications, long-term outcome, and the need for repeat surgery. Results This study is the first to document the distinguishing features between adult patients with and those without PRAS. The difference in average age was statistically significant (p < 0.001) between the study group (36.22 years) and the control group (44.30 years), as was the incidence of male patients (86.20% vs 71.91%, p = 0.020), incidence of military patients (74.71% vs 57.30%, p = 0.015), average duration of symptoms (16.13 vs 8.4 months, p = 0.016), and incidence of reactive scoliosis (19.54% vs 4.49%, p = 0.002). The most common anatomical location of disc herniation in the PRAS group was L5–S1 (51.72%) versus L4–L5 (53.93%) in the control group (p = 0.017). In terms of previous injury, motor deficits, back and/or leg pain, lateral or central location of LDH, mean anteroposterior diameter of disc herniation, hard or soft discs, and surgical complications, there was no statistical difference between the 2 patient groups. Similarly, there was no difference in recurrence rates and clinical outcomes between the patients with or without PRAS. Conclusions Posterior ring apophysis separation with LDH is probably more common in adults than is generally recognized. It must be suspected when young male patients with persistent sciatic scoliosis and no history of injury show signs of calcified LDH. Computed tomography scanning with sagittal reconstructions is the procedure of choice for diagnosing. The L5–S1 intervertebral disc level is most commonly affected, especially the superior endplate of S-1. This condition needs more extensive surgical exposure and resection to relieve the nerve impingement. The occurrence of an apophyseal lesion was not associated with recurrent disc herniation or a fair outcome.

Download Full-text

Computer Three-Dimensional Reconstruction and Pain Management for Lumbar Disc Herniation Treated by Intervertebral Foramen Endoscopy

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2019.2787 ◽

2019 ◽

Vol 9 (8) ◽

pp. 1776-1781

Author(s):

Zhaowen Peng ◽

Wenwen Zhao ◽

Shaohua Hu

Keyword(s):

Lumbar Spine ◽

Pain Management ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Three Dimensional ◽

Operation Time ◽

Control Group ◽

Intervertebral Foramen ◽

Experimental Group

Objective: Lumbar disc herniation leads the numbness and pain in the waist and lower limbs. Intervertebral foramen endoscopy is a minimally invasive procedure for the treatment of disc herniation. Adequate preoperative evaluation is conducive to this percutaneous skin surgery. The purpose of this study is to improve the efficacy of intervertebral foramen endoscopy in the treatment of lumbar disc herniation by preoperative computer three-dimensional reconstruction combined with pain management. Method: Fifty patients with lumbar disc herniation who met the indications of intervertebral foramen endoscopy were randomly divided into experimental group and control group. The control group was operated according to experience based on the common axial image. The experimental group was punctured according for three-dimensional visualization model of lumbar spine. Preoperative simulated puncture catheterization and perioperative pain management was applied. The catheterization time, operation time under endoscopy, fluoroscopy times during operation, the Visual Analogue Scale (VAS) and Japanese Orthopaedic Association (JOA) scores before and 1 d, 1 m and 3 m after operation were compared between two groups. Result: The three-dimensional visualization model of lumbar spine was reconstructed based on thin-layer data. According to the results of software measurement, the skin puncture point was located and the puncture angle was obtained. Compared with the control group, the catheterization time, operation time under endoscopy, fluoroscopy times during operation in experimental group were significantly reduced. There was no statistical difference in VAS and JOA scores between two groups before operation. Compared with control group, the VAS scores in experimental group at 1 d, and 1 m after operation were decreased statistically, while the JOA scores were increased statistically. Conclusion: Three-dimensional visualization model of lumbar spine and virtual operation planning can directly judge the feasibility of intervertebral foramen endoscopy in the treatment of lumbar disc herniation, improve the efficiency of operation, and further improve postoperative efficacy with pain management.

Download Full-text

Immediate effects of a novel walking assist device with auxiliary illuminator on patients after acute strokes

Hong Kong Physiotherapy Journal ◽

10.1142/s1013702519500100 ◽

2019 ◽

Vol 39 (02) ◽

pp. 115-124

Author(s):

Wan-Yun Huang ◽

Sheng-Hui Tuan ◽

Min-Hui Li ◽

Xin-Yu Liu ◽

Pei-Te Hsu

Keyword(s):

Gait Speed ◽

Stride Length ◽

Stance Phase ◽

Gait Cycle ◽

Swing Phase ◽

Heel Strike ◽

Assist Device ◽

Double Support ◽

Strike Angle ◽

Support Phase

Background: Many patients after acute stage of stroke are present with abnormal gait pattern due to weakness or hypertonicity of the affected limbs. Facilitation of normal gait is a primary goal of rehabilitation on these patients.Objective: We aimed to investigate whether walking assist device with auxiliary illuminator (quad-cane with laser) providing visual feedback during ambulation could improve parameters of gait cycle immediately among patients with subacute and chronic stroke.Methods: This was a cross-sectional study and 30 participants (male 23, female 7, group 1) with mean age [Formula: see text] years were recruited. Among them, 22 used ankle-foot orthosis [(AFO), group 2] and 8 did not use AFO (group 3) at usual walking. All the participants walked along a strait corridor with even surface for 20[Formula: see text]m without and with using a quad-cane with laser, respectively. A gait analyzer (Reha-Watch1 system) was used to measure the changes of the parameters of gait cycle, including stride length, cadence, gait speed, stance phase, swing phase, duration of single support and double support, the angle between toes and the ground at the time of toe-off (the toe-off angle) and the angle between calcaneus and the ground at the time of heel-strike (the heel-strike angle), before and with the use of a quad-cane with laser.Results: The increase in the heel-strike angle reached a significant difference in groups 1 2, and 3 ([Formula: see text], and [Formula: see text], respectively). However, the stride length, the gait speed, the cadence, percentage of the stance phase, swing phase, single-support phase, and double-support phase in a gait cycle, and the toe-off angle showed no significant change with the use of quad-cane with laser.Conclusion: Patients after acute stroke had an immediate and significant increase in the heel-stroke angle by using a quad-cane with laser during ambulation, which might help the patients to reduce knee hyperextension moment and lessen the pressure of heel at loading phase.

Download Full-text