Does Unilateral Lumbosacral Radiculopathy Affect the Association between Lumbar Spinal Muscle Morphometry and Bone Mineral Density?

Age-related degenerative changes lead to a gradual decrease in bone mineral density (BMD) and muscle mass. We aimed to assess the effects of decreased BMD and lumbar denervation on lumbar spinal muscle morphometry and the relationship between BMD and lumbar spinal muscular morphometry, respectively. Eighty-one patients, aged 50–85 years, diagnosed with unilateral lumbosacral radiculopathy based on electrodiagnostic studies between January 2016 and April 2021 were enrolled. BMD T scores in the lumbar spine and hip were measured using dual-energy X-ray absorptiometry. The cross-sectional area (CSA) of the psoas, multifidus, and erector spinae located in the middle of the lumbar spine, between the L3 and L4 and between the L4 and L5 levels, respectively, was measured using axial MRI. Functional CSA (FCSA) was defined as the CSA of lean muscle mass. Pearson correlation analyses were performed to evaluate the association between BMD T scores and the CSA, FCSA, and the ratio of the FCSA to the CSA (functional ratio) for each side. The CSA of lumbar spinal muscles showed no significant correlation with lumbar BMD. The FCSA and functional ratio of lumbar spinal muscles were significantly correlated with lumbar BMD. There was no correlation between femur BMD and lumbar spinal muscle morphometry.

Effectiveness of Trigger Point Dry Needling on Lumbosacral Radiculopathy among Indian Homemakers: A Randomized Controlled Trial

Background and Aim Lumbosacral radiculopathy is a typical disorder among people belonging to diverse populations. Myofascial trigger points are commonly located on the lumbar and pelvic girdle areas, which are known for aggravating pain in lumbar radiculopathy. This study was conducted to know the effectiveness of trigger point dry needling on lumbosacral radiculopathy among Indian homemakers in pain. Methods One hundred subjects between the age group of 40 to 60 years clinically diagnosed with lumbosacral radiculopathy associated with myofascial trigger points were screened, and 40 subjects who matched the inclusion criteria were enrolled to study after ethical approval. Subjects were randomly allocated into group A (n = 20) (experimental/trigger point dry needling) and group B (n = 20 control/sham needle therapy) for five sessions in a week. Outcomes were measured using a numerical pain rating scale for pain. Results The level of significance was determined by p < 0.05 at 95% confidence interval. Statistically, significant improvements were seen between the mean pre- and postscores of both the groups (p < 0.05). However, the reduction in mean pain scores was statistically more significant in group A (decrease by 65.7%) than group B (decrease by 14.1%). Conclusion Trigger point dry needling on lumbosacral radiculopathy provided to group A was more effective than intervention provided to group B control study participants.

THE COURSE OF OCCUPATIONAL LUMBOSACRAL RADICULOPATHY IN THE FOLLOW-UP HISTORY

Objective. To study the features of the course of occupational lumbosacral radiculopathy in patients in the follow-up history. Materials and methods. One hundred and ninety patients were involved in the study on the course of occupational lumbosacral radiculopathy in the follow-up history. Results. According to the clinical measures, an inpatient course was found in the 72.5% of cases; radiographically – a progressive course (84.7%). As for the neurophysiological indexes, a regressive course was observed in 58.0% of cases. Conclusion. The data was obtained on the clinicoradiological and clinical-neurophysiological dissociation of occupational radiculopathies in the follow-up history.

Selecting informative biomarkers for early diagnosis of occupational neurological diseases

Introduction. At present, the patterns of changes in the levels of biomarkers and the relationship of changes in their values with the pathogenesis of diseases caused by the impact of adverse factors of labour activity are not sufficiently studied. The most unresolved issues are the choice of informative laboratory indicators and diagnostic test systems in investigating the impact of physical factors on the working environment (vibration and physical overload) neurohumoral regulation: pituitary-adrenal pituitary-thyroid, pituitary-gonadal system and hormonal indicators of carbohydrate metabolism. The aim of the study was to determine diagnostic hormonal markers and integral indices to identify early changes in the neurohumoral status in the body of workers under the influence of working environment factors. Materials and methods. 330 workers of mining and machine-building enterprises were examined. Of these, 128 people with vibration disease, 45 people - with lumbosacral radiculopathy, combined pathology (vibration disease and lumbosacral radiculopathy) was detected in 60 persons. The preclinical stage (initial signs of diseases) was noted in 97 workers. Laboratory studies included hormones and integral indices of the pituitary-adrenal, pituitary-thyroid, pituitary-gonadal system, carbohydrate metabolism. To select the diagnostic significance of laboratory biomarkers, diagnostic sensitivity, prenosological value, pathognomonicity, direction, severity, and selectivity of changes in biomarker levels were evaluated. Results. The combined effect of vibration and physical overload on the body of workers was found to have a unidirectional and systemic impact on the levels of hormones of the pituitary-adrenal, pituitary-thyroid and pituitary-gonadal systems, increases insulin resistance. The severity of changes in neurohumoral regulation indicators depends on the nature and severity of the occupational neurological disease. The highest diagnostic sensitivity (Df = 72-74%) in vibration disease and its combination with lumbosacral radiculopathy was obtained for pituitary-gonadal hormones and indicators of insulin resistance. The lowest values of Dh are typical for the hormones of the pituitary-thyroid system (no more than 14%). To identify early changes in neurohumoral regulation in the body under the influence of vibration and physical exertion, it is most informative to determine the concentration of total testosterone, luteinizing hormone and insulin, as well as the integral pituitary-adrenal index, insulin resistance indices. To identify hidden disorders of the pituitary-thyroid system, the definition of the essential thyroid index can be used. Discussion. The results obtained allowed us to assess the nature of changes in the levels of hormones of the pituitary-adrenal, pituitary-thyroid and pituitary-gonadal systems and carbohydrate metabolism and to propose informative laboratory biomarkers reflecting early changes in neurohumoral regulation under the influence of physical factors of the working environment. Conclusions. To identify early changes in neurohumoral regulation in the body of workers under the influence of vibration and physical exertion, the most informative is the determination of the concentration of total testosterone, luteinizing hormone and insulin, the integral pituitary-adrenal index, and insulin resistance indices. To identify hidden disorders of the pituitary-thyroid system, the definition of the integral thyroid index can be used.

Outpatient management of patients with discogenic lumbosacral radiculopathy

Disсоgenic lumbosacral radiculopathy (DLSR) is less common than lumbar musculoskeletal pains, but has a worse forecast and is more often accompanied by a long disabilities. Most patients with DLSR can effectively be treated under polyclinic conditions, but it is not clear how effective conservative methods of DLSR therapy are used in real outpatient practice. This study was carried out in order to analyze the outpatient maintenance of patients with DLSR, which were surgical treatment (lumbar microdiskectomy) due to the ineffectiveness of conservative therapy.Materials and methods. 90 patients (33 men, 57 women, average age – 59.78 ± 12) years suffered surgical treatment (microdiskectomy) due to the ineffectiveness of conservative DLSR. The duration of the disease to operation ranged from 2 to 14 weeks and was an average of 6 ± 3 weeks.Results. Patients were not informed about the favorable course of the DLSR, the possibilities of natural (without surgical intervention) of the regression of the disk hernia, as well as expediency to maintain all types of activity, avoid a long bed mode. Only half of the patients were conducted by therapeutic gymnastics. 94.4% of patients received non-steroidal anti-inflammatory funds, 92.2% – muscle relaxant, 79.8% – a complex of vitamins of group B, and epidural blockade with anesthetics and corticosteroids were not used. Relatively widely used ineffective methods of therapy of the DLSR: paravertebral blockade of analgesics (42.2%), intravenous drip administration of actovegin and/or pentoxyfalline (26.7%), magnetotherapy and/or laser and therapy (36.7%).Conclusion. In an outpatient practice, patients with DLSR do not receive effective conservative treatment, which may be a reason for the early (after 6 weeks) directions for surgical treatment. Polyclinic doctors are poorly informed about the effective conservative methods of DLSR therapy.

EFFECTS OF LUMBAR SNAG AND MECHANICAL TRACTION IN PATIENTS WITH DISCOGENIC LUMBOSACRAL RADICULOPATHY

Objective: To compare the effects of lumbar sustained natural apophyseal glide and Mechanical Traction in patients with discogenic lumbosacral radiculopathy. Study Design: Quasi experimental study. Place and Duration of Study: Kanaan Physiotherapy and Spine Clinic, from Mar to Sep 2020. Methodology: A total of 44 patients were included in study in 2 groups of 22 each. Patients between ages 30-60 years having chronic radiating pain in one or both legs, patients with minimum of 25 score out of 100, on low back pain index and patients having radiculopathy were included. Exclusion criteria were history of low back pain treatment in last 90. Complications such as cancer, spine pathology and joint disease. Dice roll method was used for group allocation. Group classification was as group 1, sustained natural apophyseal glide group, and group 2, mechanical traction group. NPRS and oswestry disability index were used. Data analysis was done with SPSS version 21. Results: There is statistically significant improvement in pain as mean post treatment value for sustained natural apophyseal glide group is 2.55 ± 1.503 and for mechanical traction group is 4.05 ± 1.864, oswestry disability index and shober test results in sustained natural apophyseal glide group were also significant as compared to mechanical traction with p-value <0.05. Although pain was also decreased in mechanical traction group patients but overall sustained natural apophyseal glides were more effective. Conclusion: Sustained natural apophyseal glide are more effective in the treatment of lumber radiculopathy patients as compared to mechanical traction. Further studies.............

Rehabilitation of patients after lumbar microdiscectomy

Objective: to investigate movement-based therapy (kinesitherapy) effectiveness in the rehabilitation of patients after lumbar microdiscectomy.Patients and methods. We enrolled 90 patients (33 men and 57 women, mean age — 59.78±12.0 years) after lumbar microdiscectomy due to the ineffectiveness of conservative management of discogenic lumbosacral radiculopathy. One-half of the participants (45 patients: 15 men and 30 women, mean age — 60.24±12.0 years) underwent kinesitherapy under the supervision of a physician; in other 45 patients (18 men and 27 women, mean age — 59.33±11.0 years), kinesitherapy was not included in the radiculopathy treatment protocol. We assessed pain intensity with visual analogue scale (VAS) and disability using the Roland-Morris scale (RMS) before surgery, ten days after the surgery, and 1, 3, and 6 months after surgery.Results and discussion. We observed a significant decrease in pain intensity - up to 4 points on the VAS, and an improvement in activities of daily living up to 10 points on the RMS 10 days after microdiscectomy. After six months, there was a decrease in pain intensity according to the VAS to 2 points in the kinesitherapy group and to 3 points in the group without kinesitherapy (p=0.088), as well as an improvement in activities of daily living according to RMS up to 5 points in the kinesitherapy group and up to 8 points in the group without kinesitherapy (p=0.003). Reoperations were required in two of 45 patients in the group without kinesitherapy (4.4%) and in one of 45 patients (2.2%) in the kinesitherapy group (p≥0.05).Conclusion. Kinesitherapy can improve functional recovery in patients after lumbar microdiscectomy.