Ultrasound-guided Lumbar Facet Nerve Block

2004 ◽  
Vol 100 (5) ◽  
pp. 1242-1248 ◽  
Author(s):  
Manfred Greher ◽  
Gisela Scharbert ◽  
Lars P. Kamolz ◽  
Harald Beck ◽  
Burkhard Gustorff ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Nerve Block ◽  
Statistical Significance ◽  
Target Point ◽  
Medial Branch ◽  
Ultrasound Guided ◽  
Cross Axis ◽  
Lumbar Facet ◽  
Axis View

Background Lumbar facet nerve (medial branch) block for pain relief in facet syndrome is currently performed under fluoroscopic or computed tomography scan guidance. In this three-part study, the authors developed a new ultrasound-guided methodology, described the necessary landmarks and views, assessed ultrasound-derived distances, and tested the clinical feasibility. Methods (1) A paravertebral cross-axis view and long-axis view were defined under high-resolution ultrasound (15 MHz). Three needles were guided to the target point at L3-L5 in a fresh, nonembalmed cadaver under ultrasound (2-6 MHz) and were subsequently traced by means of dissection. (2) The lumbar regions of 20 volunteers (9 women, 11 men; median age, 36 yr [23-67 yr]; median body mass index, 23 kg/m2 [19-36 kg/m2]) were studied with ultrasound (3.5 MHz) to assess visibility of landmarks and relevant distances at L3-L5 in a total of 240 views. (3) Twenty-eight ultrasound-guided blocks were performed in five patients (two women, three men; median age, 51 yr [31-68 yr]) and controlled under fluoroscopy. Results In the cadaver, needle positions were correct as revealed by dissection at all three levels. In the volunteers, ultrasound landmarks were delineated as good in 19 and of sufficient quality in one (body mass index, 36 kg/m2). Skin-target distances increased from L3 to L5, reaching statistical significance (*, **P < 0.05) between these levels on both sides: L3r, 45+/-6 mm*; L4r, 48+/-7 mm; L5r, 50+/-6 mm*; L3l, 44+/-5 mm**; L4l, 47+/-6 mm; L5l, 50+/-6 mm**. In patients, 25 of 28 ultrasound-guided needles were placed accurately, with the remaining three closer than 5 mm to the radiologically defined target point. Conclusion Ultrasound guidance seems to be a promising new technique with clinical relevance and the potential to increase practicability while avoiding radiation in lumbar facet nerve block.

Ultrasound-guided Lumbar Facet Nerve Block

2004 ◽  
Vol 101 (5) ◽  
pp. 1195-1200 ◽  
Author(s):  
Manfred Greher ◽  
Lukas Kirchmair ◽  
Birgit Enna ◽  
Peter Kovacs ◽  
Burkhard Gustorff ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Contrast Medium ◽  
Nerve Block ◽  
Facet Joint ◽  
Target Point ◽  
Medial Branch ◽  
Ultrasound Guided ◽  
Ultrasound Technique ◽  
Computed Tomography Scans ◽  
Lumbar Facet

Background Lumbar facet nerve (medial branch) blocks are often used to diagnose facet joint-mediated pain. The authors recently described a new ultrasound-guided methodology. The current study determines its accuracy using computed tomography scan controls. Methods Fifty bilateral ultrasound-guided approaches to the lumbar facet nerves were performed in five embalmed cadavers. The target point was the groove at the cephalad margin of the transverse (or costal) process L1-L5 (medial branch T12-L4) adjacent to the superior articular process. Axial transverse computed tomography scans, with and without 1 ml contrast dye, followed to evaluate needle positions and spread of contrast medium. Results Forty-five of 50 needle tips were located at the exact target point. The remaining 5 were within 5 mm of the target. In 47 of 50 cases, the applied contrast dye reached the groove where the nerve is located, corresponding to a simulated block success rate of 94% (95% confidence interval, 84-98%). Seven of 50 cases showed paraforaminal spread, 5 of 50 showed epidural spread, and 2 of 50 showed intravascular spread. Despite the aberrant distribution, all of these approaches were successful, as indicated by contrast dye at the target point. Abnormal contrast spread was equally distributed among all lumbar levels. Contrast traces along the needle channels were frequently observed. Conclusions : The computed tomography scans confirm that our ultrasound technique for lumbar facet nerve block is highly accurate for the target at all five lumbar transverse processes (medial branches T12-L4). Aberrant contrast medium spread is comparable to that of the classic fluoroscopy-guided method.

Lumbar Facet Nerve Block: Ultrasound

2016 ◽  
Author(s):  
David A. Provenzano
Keyword(s):  
Nerve Block ◽  
Iliac Crest ◽  
Medial Branch ◽  
Ultrasound Guided ◽  
Detailed Understanding ◽  
Medial Branch Block ◽  
Body Mass Indexes ◽  
Lumbar Facet ◽  
Correct Level ◽  
The Ideal

This chapter describes the relevant anatomy and sonoanatomy and the ultrasound-guided technique for lumbar medial branch blocks. The ultrasound-guided lumbar medial branch block is an intermediate level block. Prior to performing this block, it is important to have a detailed understanding of lumbar sonoanatomy in order to be able to target the correct level, the lumbar medial branch and the L5 dorsal ramus zones. In those individuals with body mass indexes in the ideal range, current studies suggest the L3 and L4 medial branches can be successfully targeted. The L5 dorsal ramus may be challenging secondary to the iliac crest, which may limit the ultrasound views needed for the target zone. Further technical and equipment advancements are needed to improve and reduce the existing limitations associated with the ultrasound-guided lumbar medial branch block technique.

Pre-pregnancy body mass index is associated with offspring body composition in adulthood before adiposity-related disorders: a retrospective cohort

2020 ◽  
pp. 1-17
Author(s):  
Ilana Eshriqui ◽  
Angélica Marques Martins Valente ◽  
Luciana Dias Folchetti ◽  
Bianca de Almeida-Pititto ◽  
Sandra Roberta G. Ferreira
Keyword(s):  
Body Mass Index ◽  
Body Composition ◽  
Body Mass ◽  
Body Fat ◽  
Retrospective Cohort ◽  
Statistical Significance ◽  
Directed Acyclic Graphs ◽  
Health Study ◽  
Appendicular Skeletal Muscle ◽  
Three Body

Abstract Objective: To investigate the association between maternal pre-pregnancy body mass index (BMI) and offspring body composition in adulthood. Design: Retrospective cohort. Undergraduates of nutrition or nutritionists were recruited at the baseline of the Nutritionists’ Health Study between 2014 and 2017. Maternal pre-pregnancy BMI and current life aspects were self-reported through online questionnaires. Three body compartments were DXA-determined. The following variables were obtained: body-fat (%), fat mass index (FMI) (kg/m2), android-to-gynoid fat ratio, visceral adipose tissue (VAT) (cm3), appendicular skeletal muscle mass index (ASMI) (kg/m2), total bone and femur mineral content (g) and density (g/cm2). Linear regression adjusted according to directed acyclic graphs recommendation was performed. Setting: São Paulo, Brazil. Participants: Healthy non-pregnant women (aged 20-45 years) (n=150). Results: Median age and BMI were 22 years (IQR=20; 29) and 22.3 kg/m2 (IQR=20.4; 25.3). Pre-pregnancy BMI≥25 kg/m2 was reported by 14.7% of mothers. In fully adjusted models, maternal pre-pregnancy BMI was associated with their daughters’ body-fat % (β=0.31; 95%CI=0.0004; 0.63), FMI (β=0.17; 95%CI=0.03; 0.30, android-to-gynoid ratio (β=0.01; 95%CI=0.004; 0.02) and VAT (β=0.09; 95%CI=0.02; 0.16), but not with total bone density (β=0.001; 95%CI=-0.003; 0.006) and content (β=7.13; 95%CI=-4.19; 18.46). Direct association with ASMI was also detected, but lost statistical significance when participants whose mothers were underweight were excluded. Conclusions: Maternal pre-pregnancy body mass index was directly associated with offspring general and visceral adiposity but seem not to be associated with bone mass. Results reinforce importance of avoiding excess of maternal adiposity, as an attempt to break the vicious cycle of obesity transmission.

scholarly journals One year change of knee cartilage morphology in the first release of participants from the Osteoarthritis Initiative progression subcohort: association with sex, body mass index, symptoms and radiographic osteoarthritis status

2008 ◽  
Vol 68 (5) ◽  
pp. 674-679 ◽  
Author(s):  
F Eckstein ◽  
S Maschek ◽  
W Wirth ◽  
M Hudelmaier ◽  
W Hitzl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Body Mass ◽  
Statistical Significance ◽  
Weight Bearing ◽  
Rate Of Change ◽  
Cartilage Loss ◽  
Knee Oa ◽  
Symptomatic Knee ◽  
Osteoarthritis Initiative

Objective:The Osteoarthritis Initiative (OAI) is a multicentre study targeted at identifying biomarkers for evaluating the progression and risk factors of symptomatic knee OA. Here cartilage loss using 3 Tesla (3 T) MRI is analysed over 1 year in a subset of the OAI, together with its association with various risk factors.Methods:An age- and gender-stratified subsample of the OAI progression subcohort (79 women and 77 men, mean (SD) age 60.9 (9.9) years, body mass index (BMI) 30.3 (4.7)) with both frequent symptoms and radiographic OA in at least one knee was studied. Coronal FLASHwe (fast low angle shot with water excitation) MRIs of the right knee were acquired at 3 T. Seven readers segmented tibial and femoral cartilages blinded to order of acquisition. Segmentations were quality controlled by one expert.Results:The reduction in mean cartilage thickness (ThC) was greater (p = 0.004) in the medial than in the lateral compartment, greater (p = 0.001) in the medial femur (−1.9%) than in the medial tibia (−0.5%) and greater (p = 0.011) in the lateral tibia (−0.7%) than in the lateral femur (0.1%). Multifactorial analysis of variance did not reveal significant differences in the rate of change in ThC by sex, BMI, symptoms and radiographic knee OA status. Knees with Kellgren–Lawrence grade 2 or 3 and with a BMI >30 tended to display greater changes.Conclusions:In this sample of the OAI progression subcohort, the greatest, but overall very modest, rate of cartilage loss was observed in the weight-bearing medial femoral condyle. Knees with radiographic OA in obese participants showed trends towards higher rates of change than those of other participants, but these trends did not reach statistical significance.

scholarly journals Abdominal obesity: prevalence, sociodemographic- and lifestyle-associated factors in adolescents

2017 ◽  
Vol 27 (1) ◽  
pp. 56 ◽  
Author(s):  
Willian R. Tebar ◽  
Luiz Carlos M. Vanderlei ◽  
Catarina C. Scarabotollo ◽  
Edner F. Zanuto ◽  
Bruna T. C. Saraiva ◽  
...  
Keyword(s):  
Physical Activity ◽  
Body Mass Index ◽  
Body Weight ◽  
Public Schools ◽  
Sedentary Behaviour ◽  
Body Mass ◽  
Abdominal Obesity ◽  
Associated Factors ◽  
Statistical Significance ◽  
Obesity Prevalence

Objectives: The aim of this study was to determine the prevalence of abdominal obesity and its associated factors among adolescents, independent of confounders. Method: A sample of 14–17-year-old individuals (n=1.231), who were students from Londrina/PR-Brazil public schools, was studied. A questionnaire about physical activity, sedentary behaviour and socioeconomic conditions was applied. Anthropometry was composed of body weight (kg), height (m), body mass index (BMI=kg/m²) and waist circumference (cm). The association of abdominal obesity and independent variables was assessed using the chi-square test and the magnitude of associations was verified using Binary Logistic Regression in an unadjusted model and adjusted for confounders (gender, age, socioeconomic status, physical activity and sedentary behaviour). The confidence interval and statistical significance were set at 95% and 5%, respectively, using SPSS v15.0. Results: The abdominal obesity prevalence was 17.5% (CI = 15.4%–19.6%), and was higher in boys than in girls. Adolescents with abdominal obesity had higher values of body weight, height, body mass index and sedentary behaviour compared to eutrophic individuals. Being male increased the risk of abdominal obesity by 36% in adolescents. This risk was two times higher in those with high levels of sedentary behaviour. Conclusion: Abdominal obesity was significantly associated with gender and high levels of sedentary behaviour, regardless of confounding factors. Lifestyle habits are important modifiable risk factors that can effectively contribute to the reduction of obesity from an early age.

scholarly journals Normal values of coronary arteries branching height in women

2021 ◽  
Vol 27 (4) ◽  
pp. 41-46
Author(s):  
U.Ye. Pidvalna ◽  
D.M. Beshley ◽  
M.Z. Mirchuk ◽  
L.R. Mateshuk-Vatseba
Keyword(s):  
Body Mass Index ◽  
Coronary Artery ◽  
Body Mass ◽  
Coronary Arteries ◽  
Body Surface ◽  
Left Coronary Artery ◽  
Statistical Significance ◽  
Lower Edge ◽  
The Mean ◽  
The Right

Morphometric analysis of the structures of the aortic bulb and coronary arteries is necessary for the planning of cardiac surgery and endovascular interventions. The aim of the study was to determine the height of the coronary arteries branching in healthy women of Lviv city and Lviv region and to determine the relationship between the height of the location of the orifice of the coronary artery with anthropometric indicators. Fifteen computed tomography images with contrast of female thorax without heart and ascending aortic lesions (normal) were selected for the study. The height of the upper and lower edges of the coronary arteries was measured; height of Valsalva sinuses. The comparison of the mean values was performed according to the Student’s t-test. The correlation between the observed variables (age, height, body weight, body mass index, body surface area, height of the sinuses of Valsalva) was calculated using the Pearson linear correlation method (r). According to the study, the population group consisted of persons of the second period of adulthood (46.67 %) and the elderly (53.33 %). According to the body mass index, 80 % were overweight or obese I-II degree. The mean height of the coronary artery orifice in women without structural changes of the heart and ascending aorta was: 11.19±1.96 mm for the left and 11.68±1.80 mm for the right. The height of the orifice of the right and left coronary arteries were almost the same, without statistical significance (p=0.26). Analysis of the correlation between the values of the height of the orifice of the coronary artery did not show a probable dependence on height, weight, age, body mass index and body surface area. There is a direct relationship between the parameters of the height of the lower edge of the right coronary artery and the height of the upper edge of the right coronary artery (r=+0.75, p=0.001) and between the value of the lower edge of the left coronary artery and the upper edge of the left coronary artery (r=+0.63, p=0.01). Thus, the analysis of the correlation between the values of the height of the orifice of the coronary artery in women in norm and anthropometric indicators did not show a significant relationship. There was no statistical significance between the indicators of the height of the orifice of the right and left coronary arteries in women.

scholarly journals Cross-sectional study on the weight and length of infants in the interior of the State of São Paulo, Brazil: associations with sociodemographic variables and breastfeeding

2009 ◽  
Vol 127 (4) ◽  
pp. 198-205 ◽  
Author(s):  
Julia Laura Delbue Bernardi ◽  
Regina Esteves Jordão ◽  
Antônio de Azevedo Barros Filho
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Statistical Significance ◽  
Randomized Study ◽  
The Body ◽  
Nutrition Status ◽  
Rank Test ◽  
Cross Sectional ◽  
Sociodemographic Variables ◽  
Significance Level

CONTEXT AND OBJECTIVE: Increasing obesity is starting to occur among Brazilians. The aim of this study was to investigate the weight and length of children under two years of age in relation to sociodemographic variables and according to whether they were breastfed. DESIGN AND SETTING: Cross-sectional randomized study conducted in 2004-2005, based on the declaration of live births (SINASC) in Campinas, Brazil. METHODS: 2,857 mothers of newborns were interviewed and answered a questionnaire seeking socioeconomic and breastfeeding information. The newborns' weights and lengths were measured at the end of the interviews and the body mass index was calculated. Percentiles (< 15 and > 85) and Z-scores (< -1 and > +1) were used for classification based on the new growth charts recommended by WHO (2006). The log-rank test, multiple linear regression and binomial test (Z) were used. The statistical significance level used was 5%. RESULTS: The predominant social level was class C. The median for exclusive breastfeeding was 90 days; 61.25% of the children were between P15 and P85 for body mass index and 61.12% for length, respectively. Children whose mothers studied for nine to eleven years and children whose mothers were unemployed presented lower weight. Children whose mothers worked in health-related professions presented lower length when correlated with breastfeeding. CONCLUSION: The breastfeeding, maternal schooling and maternal occupation levels had an influence on nutrition status and indicated that obesity is occurring in early childhood among the infants living in the municipality.

scholarly journals Long-Term Postoperative Total Knee Arthroplasty Flexion Scores in Relation to Body Mass Index

2020 ◽  
Author(s):  
Matthew A. Siegel ◽  
Michael J. Patetta ◽  
Angie M. Fuentes ◽  
Armaan S. Haleem ◽  
Craig W. Forsthoefel ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Total Knee Arthroplasty ◽  
Body Mass ◽  
Knee Arthroplasty ◽  
Statistical Significance ◽  
P Value ◽  
Preoperative Body Mass Index ◽  
Total Knee

AbstractKnee range of motion (ROM) is an important postoperative measure of total knee arthroplasty (TKA). There is conflicting literature whether patients who are obese have worse absolute ROM outcomes than patients who are not obese. This study analyzed whether preoperative body mass index (BMI) influences knee ROM after patients' primary TKA. A retrospective investigation was performed on patients, who underwent primary TKA at an academic institution, by one of three fellowship-trained adult reconstruction surgeons. Patients were stratified according to their preoperative BMI into nonobese (BMI < 30.0 kg/m2) and obese (BMI ≥ 30.0 kg/m2) classifications. Passive ROM was assessed preoperatively as well as postoperatively at patients' most recent follow-up visit that was greater than 2 years. Mann–Whitney U tests were performed to determine statistical significance at p-value <0.05 for ROM outcomes. No statistically significant differences were observed when ROM in the nonobese group was compared with ROM in the obese group both preoperatively (105.73 ± 11.58 vs. 104.14 ± 13.58 degrees, p-value = 0.417) and postoperatively (105.83 ± 14.19 vs. 104.49 ± 13.52 degrees, p-value = 0.777). Mean follow-up time for all patients was 4.49 ± 1.92 years. In conclusion, long-term postoperative ROM outcomes were similar between patients who were nonobese and patients who were obese.

scholarly journals Genome-wide Genetic Contribution to Diet Response in an Epidemiological Dataset (P15-018-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Kenneth Westerman ◽  
Jose M Ordovas
Keyword(s):  
Body Mass Index ◽  
Longitudinal Data ◽  
Body Mass ◽  
White Women ◽  
Dietary Intervention ◽  
Statistical Significance ◽  
Cross Sectional ◽  
Statistical Correlations ◽  
Mathematical Correlation ◽  
Genome Wide

Abstract Objectives Many gene-diet interactions have been uncovered for obesity and other cardiometabolic risk factors, but truly personalized nutritional recommendations will require the incorporation of an individual's full genome in predicting response to diet. Statistical genetics studies typically require thousands of individuals, limiting the ability of dietary intervention trials to answer these genome-wide nutrigenetic questions. We sought to explore a novel approach for identifying the genetic architecture of the diet-body mass index (BMI) relationship using an epidemiological dataset. Methods As a mathematical correlation is defined as the expected product of two standardized variables, it may be possible to estimate the genetic signal describing an underlying diet-BMI correlation by predicting their product. Statistical simulations were performed to assess the ability of this method to pick up pre-specified effects of genotype on diet response. In white women from the longitudinal Women's Health Initiative (WHI) dataset, the product of log-transformed fat-to-carbohydrate ratio (F: C) and body mass index (BMI) (both variables standardized) was calculated both cross-sectionally at baseline (n = 9357) and with respect to longitudinal changes in these variables before follow-up (n = 1333). Plink and GCTA tools were used to estimate the genotype-based heritability of these products, as well as that of the change in BMI in response to a separate intervention in WHI focused partially on fat reduction. Results Simulations demonstrated that the method is sensitive to changes in the underlying effect sizes, but is able to detect underlying statistical correlations as intended. Genetic heritability estimates using cross-sectional data were negligible, while those using longitudinal data approached statistical significance (variance explained = 14%, P = 0.07). BMI changes in the dietary modification trial showed non-significant heritability (v.e. = 4%), which was insufficient to validate any genetic correlation with the longitudinal results. Conclusions While cross-sectional data may contain too much noise, this method shows promise for the detection of genome-wide contributions to diet response in longitudinal data, and should be investigated further in larger datasets and with alternative phenotypes. Funding Sources This study was supported by the NHLBI T32 training grant.

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