The Dermal Sinus: About 29 Cases and Review of the Literature

The term spina includes several types of congenital malformations including closed spinal dysraphisms, among these 10% are dermal sinuses.Our series includes 29 patients, the majority of which were asymptomatic, but these can present with different clinical pictures including neurological and / or infectious signs indicating a neglected dermal sinus and which therefore requires urgent treatment in the environment. Neurosurgical.MRI confirmed the diagnosis showing the dermal sinus tract communicating from the surface of the skin to the intra-dural space.Once the diagnosis has been made, surgical treatment becomes imperative and urgent because, despite the benignity of the lesion, the majority of which are located in the lumbar region, can lead to formidable neurological sequelae compromising the functional prognosis or even the vital prognosis in some cases.All of our patients were operated on and we obtained 90% good results, however we deplore one case of aggravation and one death.

Therapeutic Education and Physiotherapy in Low Back Pain Management

BACKGROUND: Low-back pain (LBP) is one of the most common musculoskeletal problems; it is the leading cause of disability worldwide. Therapeutic patient education is a method that enables health care professionals to pass on their knowledge and experience to patients so that they can participate consciously and actively in their recovery. AIM: The present study aims to examine the effect of therapeutic education (TE) combined with a specific physiotherapy (PT) approach in people with LBP. МАTERIALS AND METHODS: This was an experimental pre- and post-study design. The study involved 25 patients, mean age 43.08 ± 12 years, divided into two groups: experimental group (EG), with TE (n =18) and control group (CG), without TE (n = 7). The PT treatment frequency and duration were consistent between groups. The patients were monitored for one month, and the intervention under supervision – face-to-face and self-monitored home-based PT have been organized. The included outcome measures were Oswestry Disability Index, Tampa Scale for Kinesiophobia, STarT Back Screening Tools, and the movement-induced pain in the lumbar spine. RESULTS: At the end of the study improved pain-free movements in the lumbar region, functionality, reduced catastrophizing was observed in both groups. There is a tendency for better results in the EG compared to the CG in terms of functionality and pain-free movement. The subjective feeling of the catastrophizing was reduced only in the EG below the cut-off score from 45.2 ± 7.7 to 33.2 ± 3.3 points. CONCLUSION: TE in combination with PT interventions improves functional abilities, decreases the pain during movements, and the subjective perception of kinesiophobia. The results suggest TE should be included in a LBP management approach.

Evaluation of Bone Marrow Texture and Trabecular Changes With Quantitative DCE-MRI and QCT in Alloxan-Induced Diabetic Rabbit Models

PurposeTo investigate whether the microvascular permeability of lumbar marrow and bone trabecular changes in early-stage diabetic rabbits can be quantitatively evaluated using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), quantitative computed tomography, and texture-analyzed permeability parameter Ktrans map of DCE-MRI.Materials and MethodsThis prospective study included 24 rabbits that were randomly assigned to diabetic (n = 14) and control (n = 10) groups. All rabbits underwent sagittal MRI of the lumbar region at 0, 4, 8, 12, and 16 weeks after alloxan injection. Pearson correlation coefficient was performed to determine the correlation between permeability parameter and bone mineral density (BMD). Repeated-measures ANOVA was used to analyze the changes in lumbar BMD over time in each group and the texture parameters of diabetic rabbit lumbar marrow at different time points. Mann–Whitney U rank sum test was used to compare the differences of each index between the two groups and calculate the area under the curve (AUC).ResultsBMD was correlated with Ktrans, Kep, and Ve but not with Vp. At weeks 0–16, the BMD of the rabbits in the diabetic and normal groups was not statistically significant, but the change in BMD showed an overall downward trend. For texture analysis, entropy, energy, and Uniformized positive pixel (UPP) parameters extracted from the Ktrans map showed significant differences from week 0 to 16 between the two groups. The identification ability at 8–12 weeks was higher than that at 12–16 weeks, and the AUCs were 0.734, 0.766, and 0.734, respectively (P < 0.05 for all).ConclusionsThe changes in BMD measured using quantitative computed tomography occurred later than those measured using bone trabecular morphometry. Texture analysis parameters based on DCE-MRI quantitative parameter Ktrans map are feasible to identify early changes in lumbar marrow structure in diabetic rabbits.

Magnetic resonance imaging findings and antemortem cytologic diagnosis of intramedullary spinal cord ependymoma in a dog

CASE DESCRIPTION A 3-year-old 31.1-kg castrated male mixed-breed dog was evaluated because of a 1- to 2-week history of paraparesis, knuckling of the hind feet, and difficulty posturing to urinate or defecate. CLINICAL FINDINGS The dog was paraparetic but weakly ambulatory with a kyphotic posture, a mildly decreased patellar reflex in the right pelvic limb, increased tone in both pelvic limbs, and marked hyperesthesia on paraspinal palpation of the lumbar region. The urinary bladder was enlarged and firm on palpation. Neuroanatomic findings were primarily consistent with localization to the T3-L3 spinal cord segments. Magenetic resonance imaging of the thoracolumbar spinal column revealed a discrete intramedullary spinal cord mass from the cranial aspect of L4 to the middle of L5. The mass was sampled by fine-needle aspiration, and on cytologic evaluation, the suspected diagnosis was an ependymoma. TREATMENT AND OUTCOME Owing to poor prognosis and limited treatment options, the owner elected euthanasia. Postmortem examination of the spinal cord and histologic findings for samples of the mass supported a likely diagnosis of ependymoma. CLINICAL RELEVANCE Ependymoma is a rare neoplasm in dogs but should be considered in young patients with evidence of a tumor in the CNS. Fine-needle aspiration of the spinal cord mass was possible in the dog of this report, and the cytologic findings provided useful diagnostic information.

Pre-experimental Study to Assess the Effectiveness of Warm Compress on Lumbar Region during First Stage of Labour among Primi Parturient Mothers in Labour Room of Selected Hospitals at Amravati

The goal of this study was to determine the intensity of pain experienced by primiparturient women during the first stage of labour. To see how beneficial a warm compress is on the lumbar area. To see if there's a link between labour discomfort and certain demographic factors. At the 0.05 level of significance, the post-test pain score will be lower than the pre-test pain score. The research method chosen was quantitative, and the study design was pre-experimental, pre-test, and post-test. Purposive sampling was used to collect data from 60 primiparturient moms in the early stages of labour. The research was carried out at Amravati's Dayasagar Hospital. A pre-test was done using a numerical pain scale to determine pain levels among primiparturient moms who met the inclusion criteria. In the initial stage of labour, a warm compress on the lumbar area is applied for 15 minutes every half hour for four hours. The numerical pain scale is used to measure post-test pain levels. In the current study, 53.3 percent of primigravida moms in the control group reported moderate pain (scoring 4-6) and 46.6 percent had severe pain in post-test 1. (score 7-10). 36.6 percent had moderate pain (scoring 4-6) and 63.3 percent had severe pain (7-10) in post-test 2, while 13.3 percent had moderate pain (4-6) and 86.6 percent had severe pain in post-test 3. (score 7-10). In post-test 1, 70% of the experimental group experienced moderate pain (scoring 4-6) and 30% had severe pain (score 7-10). In post-test 2, 66.6 percent of participants reported moderate pain, while 33.3 percent reported severe pain. In post-test 3, 56.6 percent of participants reported moderate pain, while 43.3 percent reported severe pain. As a result, it may be stated that using a warm compress to relieve pain was successful.

Relationship between Muscle Tone of the Erector Spinae and the Concave and Convex Sides of Spinal Curvature in Low-Grade Scoliosis among Children

The objective of the present research was to assess the relationship between muscle tone of the erector spinae and the concave and convex sides of spinal curvature in low-grade scoliosis found among children. The study included 251 children, aged 7–8. Examination of the spine and body posture was carried out using the Diers Formetric III 4D optoelectronic method. Surface electromyography (sEMG) was used to assess erector spinae muscle tone. The trial was carried out using the 14-channel Noraxon TeleMyo DTS apparatus. The highest generalised tone (sEMG amplitude) of the erector spinae occurred in the case of scoliosis. The higher the angle of curvature, the greater the erector spinae muscle tone. Regardless of the position adopted during examination of the thoracic spine, greater erector spinae tone (sEMG amplitude) was exhibited on the convex side of the spinal curvature. However, in the area of the lumbar spine, greater tone (sEMG amplitude) of the erector spinae occurred on the curvature’s concave side. The exception was the test performed in a standing position, during which greater muscle tone was noted on the side of the convex curvature. In therapeutic practice, within the thoracic section, too tense erector spinae muscles should be stretched on the convex side of the scoliosis, while in the lumbar region, this should be performed on the concave side. However, each case of scoliosis requires individually tailored treatment. The current research has applicative value and does fill a research gap with regard to erector spinae muscle tone in young children experiencing low-grade scoliosis. The development of scoliosis is associated with asymmetry and an increase in erector spinae tone. The uneven distribution of its tone, occurring on both sides of the spine and in its various segments, causes destabilisation and its abnormal progression.

Effect of Parameters on Lumbar Compressive Force during Patient Transfer

Patient transfer (PT) tasks are a significant cause of low back pain (LBP) in caregivers. Adopting proper motion strategies is an effective and inexpensive approach to reduce the risk of LBP. However, since the standardization of PT tasks is not specified in ISO 11228, there is an increasing need to develop a quantitative assessment method for the lumbar safety of caregivers. Therefore, we aim to determine the effect of representative factors, extracted from caregivers’ movements and of external force, on peak compressive force (CF) in patient transfer tasks using the lumbar compressive force as a criterion. The CF at the lumbar region is estimated using a biomechanical simulator, and regression analysis is performed between the estimated CF and representative factors. The results imply that peak CF occurs in the incipience of transfer and occurs after the occurrence of the peak trunk angle. The results also indicate that the peak CF can be reduced by preventing the representative factors from simultaneously reaching the maximum values. In this study, we provide a method of reducing peak CF by estimating the timing and magnitude of the peak to help caregivers assess the severity of LBP risk in actual PT, which is expected to contribute to the standardization of PT tasks.

Morphometric analysis of the lumbar vertebrae and intervertebral discs in relation to abdominal aorta: CT-based study

Purpose Although lumbar discectomy is the most common procedure in spine surgery, reports about anatomical relations between discs and prevertebral vessels are limited. Aim of this research was to investigate morphometric of the lumbar region and the relations between intervertebral discs (IVDs) and abdominal aorta. Methods 557 abdominal computed tomography scans were assessed. For each spinal column level from Th12/L1 down to L4/L5, we investigated: intervertebral disc’s and vertebra’s height, width, length, and distance from aorta or common iliac artery (CIA). Those arteries were also measured in two dimensions and classified based on location. Results 54.58% of patients were male. There was a significant difference in arterial-disc distances (ADDs) between genders at the levels: L1/L2 (1.32 ± 1.97 vs. 0.96 ± 1.78 mm; p = 0.0194), L2/L3 (1.97 ± 2.16 vs. 1.15 ± 2.01 mm; p < 0.0001), L3/L4 (2.54 ± 2.78 vs. 1.71 ± 2.61 mm; p = 0.0012), also for both CIAs (left CIA 3.64 ± 3.63 vs. 2.6 ± 3.06 mm; p = 0.0004 and right CIA: 7.96 ± 5.06 vs. 5.8 ± 4.57 mm; p < 0.001)—those ADDs were higher in men at all levels. The length and width of IVD increased alongside with disc level with the maximum at L4/L5. Conclusion Bifurcations of the aorta in most cases occurred at the L4 level. Collected data suggest that at the highest lumbar levels, there is a greater possibility to cause injury of the aorta due to its close anatomical relationship with discs. Females have limited, in comparison to males, ADD at L1/L2, L2/L3, and L3/L4 levels what should be taken into consideration during preoperative planning of surgical intervention.

Optimizing Backrest Geometry to Minimize Interfacial Pressure Concentrations in the Mid-To-Lumbar Region During Leg Press Resistance Training

The leg press is a resistance training (RT) exercise common to both weight- and powerlifting, where spine-related injuries remain prevalent. Here, the elevated loading has the potential to result in increased pressure on vertebral bodies and introduce the risk of spinal injury. This study therefore investigates back interfacial pressure under leg press loading conditions and offers design recommendations to minimize spatial pressure concentrations. A pressure mat was used to assess the back-backrest interfacial pressure distribution of 15 subjects executing RT leg-presses at 50% bodyweight, over 16 different back-support geometries. Real-time forces, knee angles, and pressures were captured. The resulting data show that more prominent (?2.1 cm) back-supports, positioned 19cm above the seat pan typically produced greater peak pressures (41.8±7.2 kPa). Conversely, less prominent supports (~0.7 cm) generally achieved lower peak pressures (with greater distribution). Our data suggest that the most prudent choice for fixed-shape backrests to best distribute interfacial pressure on leg-press devices is to incorporate shallow convex supports (~0.7 cm), and locate them away from P=19 cm. The result is surprising as this prominence location is a common ergonomic feature. If an adjustable backrest is considered, peak pressures may be reduced by up to 26±8% (9.7±3.1 kPa) compared to flat geometries.

Psychological Assessment of Control and Coping with Neuropathic Pain in the Lumbar Spine

Background: Pain in the lumbar spine is an increasingly common problem, not only neurological or orthopaedic, but also psychological. In epidemiological studies on the prevalence of neuropathic pain, conducted in countries such as the United Kingdom, the United States France, and Brazil, it has been shown that the prevalence of chronic pain with neuropathic properties is estimated at 7-10%. Chronic neuropathic pain is more common in women (8% versus 5.7% in men) and in patients > 50 years of age (8.9% versus 5.6% in women < 49 years old). It most frequently concerns the lumbar region and lower limbs. However, in Germany, it has been revealed that 40% of all patients experience at least some features of neuropathic pain such as burning, numbness and/or tingling, especially those with chronic pain in the lumbar spine and radiculopathy. Chronic pain not only hinders a patient's daily life activities, but over time, it has negative impact on the patient's psyche: it reduces his/her well-being, causing anxiety, fear, helplessness, regret and even hostility. It should be emphasized that each of these reactions is an individual feature. Objectives: The aim of the study is to assess pain control as well as the strategies of coping with neuropathic pain in the lumbar spine. Material and methods: The study comprised 50 people with neuropathic pain in the lumbar region, including 41 women and 19 men. The average age of the respondents was 56 years, the average duration of the symptoms was 8 years. The following questionnaires were used to assess neuropathic pain: Lanss Pain Scale and DN4, and the Visual Analogue Scale (VAS) to assess pain intensity. For Pain Control Assessment - the Beliefs Questionnaire for Pain Control (BPCQ) and Pain Coping Strategy Questionnaire (CSQ). Results: Among the 3 measured factors of pain control, internal control dominates in young people, external control in middle-aged individuals, and the attitude towards random events in the elderly. There was significant statistical dependence between pain coping strategy and type of pain control. Conclusions: With the duration of pain and the age of the patient, random events play an increasingly important role in pain control. Hence, tests on pain control and coping should be carried out among patients as this would determine the most favourable treatment method.